Episode 113: An Anecdote on REDs and Holistic Health as an Athlete

Written By Jim Anderson

In this week’s episode, we share an honest, nuanced conversation about REDs (Relative Energy Deficiency in Sport) and holistic athlete health. Katie opens with some reflections on navigating the decision to take a step back from running late in pregnancy, using purpose, trends, and body awareness to guide her training. From there, Elena shares her full health story for the first time: the perfect storm that led to REDs, the crash, a long and messy recovery, and what ultimately helped her heal. We talk through warning signs, blood work, compounding life stress, weight gain nuance, mental health, and why performance and health are not the same thing. This episode is an anecdote—not a diagnosis—but it’s meant to offer language, context, and hope to athletes who may recognize pieces of themselves in the story. If you’re navigating burnout, underfueling, hormonal disruption, or questioning whether your body is asking for something different, this is a deeply important listen. Check it out!

Katie’s insights: currently navigating the decision to stop (or highly reduce) running in very late pregnancy

  • Disclaimer as always: this is a very personal decision and you should always draw on your performance bubble to help think it through!

  • Context: feels like baby has gone through a BIG growth spurt recently and running is increasingly uncomfortable anatomically! Starting to really entertain the idea of not making running a primary exercise modality for me anymore. For pretty much all of pregnancy, have run 3-4x per week, 20-30 miles.  

  • Big question I am asking myself - Is running still serving the purpose that I wanted it to? Purposes:

    • Curiosity - what can my body do in pregnancy? I am still curious, but I think I have an answer (that running isn’t super comfortable anymore)

    • Joy/mental health - hard to really embrace joy when you are physically uncomfortable, which can make you feel not great mentally!

    • Community - not really running with other people right now because timing and feel is so unpredictable. Honestly easier to be social doing stadiums or treadmill side by side by with someone.

    • Health - cardio is great but at this point there are other ways to hit a cardio stimulus that feel a little better on my body. Uphill TM, stadiums, etc. Also, feels like my gait is changing enough that some low back discomfort and other niggles may be worsening a bit, which is worth paying close attention to. 

    • Getting outside - just got a new parka which means I can get outside to take a long walk even when it’s cold. I live in a city so I get a lot of steps walking to gym, etc. Also, it’s winter! Bringing it back to the joy piece, getting outside is not that enjoyable anyway. 

    • Performance/training - maybe, but either way I have to take time off postpartum and will be returning to sport with x-training anyway, so I don’t think there’s a huge gain that would come from forcing myself to keep going at this stage. See also: potentially compromised bone health at the end of pregnancy and early postpartum (Episode 103). 

  • But some broader thoughts:

    • Look for trends - running has felt bad for 3+ runs in a row (or increasingly bad) rather than running felt bad once. Is it a pattern or just the rule of thirds? 

    • Don’t have to say full stop/ never at this point. If we get a really nice day and I feel good, I am totally open to going out for a run! May try run/walk intervals too to see how that feels. Curiosity mindset continues!

    • Am I sad about this ending? Honestly I got to run for SO much longer than I expected I would that I am really ok with it. It also feels very temporary and I am confident in my ability to return, probably sooner than we think!

    • The above principles/ thought process are relevant to non-pregnant athletes as well. Always useful to ask yourself “is X serving its intended purpose right now?” and KNOW what your purpose is. If not, you can change it up and that is ok! 

      • Advice for pregnant athletes would be to ask yourself the big “what is my purpose?” question at the beginning of pregnancy and let that guide how you approach movement. For example if your purpose is joy and a certain type of movement is not bringing you joy, you probably shouldn’t be doing it!

    • What I plan to do for continued movement:

      • Strength! Super important, enjoying it, enjoying working with trainer, and the lack of repetitive motion thing seems helpful 

      • Walking! Lots of it. Getting outside is important in the winter for mental health.

      • Swims! Maybe 1x per week. More of a float than anything else, but feels good to be weightless and “lay on my stomach” in a way that I otherwise can’t

      • Uphill treadmill still feeling good for short bouts (20-30m) and more easily scalable to easier/harder than running

      • Maybe: stadiums, easy hikes, etc.

      • Note: all of the above is PLENTY for my purpose of curiosity, joy, health, etc. 

Main content – Elena’s Health Story:

  • Setting the context – I know we talked at different points on the podcast about my journey in 2024 and 2025 and what I was working through, but I’ve never reflected holistically on the entire narrative. Now I’m back to feeling more like myself than I have in a long time (since pre-2024) and can tell a more complete narrative around what happened and what I’ve learned, so that’s the goal today. 

  • Before I start, I need to say: this is an anecdote, an n of 1. Nothing I share should be taken as an exact diagnosis or prescription. REDs and overtraining look different for everyone - there's so much nuance, so much we don't understand. I’m telling this because when I was in the depths of it, I desperately searched for anyone who had experienced something similar, both for hope and for ideas. When I finally came across a few anecdotes buried in reddit or old articles, I would just start crying, I think both because I was recognizing the same experience in myself and because I was terrified that I’d never be the same athlete I once was

  • General agenda: 

    • my perfect storm, my crash, my messy recovery, and now what feels like my more complete recovery

    • Hitting on the symptoms– both medical and subjective– that I experienced

    • What actually helped vs. what I tried

    • Lessons learned

    • What’s next

  • Stage 1: Jan - May 2024: 

  • Won Black Canyons and Canyons 100, felt strong

  • Already probably on the edge energetically - had been building high volume for months and not fueling most runs. Didn’t have much of an appetite and often work up hungry. Didn’t think much of it since I felt good running. 

  • Ran Canyons but fueled entirely on Spring energy product with 1/3 advertised calories

  • The next day: found out my close friend died

  • First 100-miler - didn't know what normal recovery should feel like

  • Lost appetite completely, probably severely under-fueled recovery

  • Sleep collapsed to 4 hours/night and never recovered

  • One week later: corticosteroid for poison oak all over my legs and the stress of grief and travel for my friend→ was surely in a BIG hole. 

  • Compounding stress:

  • New job, constant travel (12 weeks straight of travel May-August)

  • Trying to return to training while body not feeling right

  • Operating on total autopilot - "always in a frenzy, trying to fill time but also couldn't focus"

  • Italy race disaster

  • Weird symptoms throughout:

    • Only sleeping 4-5 hours, waking wide awake, often in a sweat

    • Blacking out when standing up too fast

    • Muscles not recovering from the 100

    • Lack of focus and deep fatigue

    • But thinking "I'm just grieving and recovering from a hard race"

    • However also being very hard on myself for not just being able to function how I felt “normally”

  • Never thought of REDs because I didn’t feel like I fit any of the stereotypes I had heard– I was not actively restricting food, I was not “super lean”, I had no injury history. But I did have a history of an eating disorder in college and was not actively trying to fuel my body enough. 

  • Stage 1 summary: I thought I could problem-solve my way out. But I was treating symptoms while adding more stress. My body had entered a stress state it couldn't exit, and I didn't realize the friend's death, the under-fueling, the corticosteroid, the travel - they were all compounding. The body doesn't differentiate between physical and emotional stress.

  • Stage 2: The crash (July/August - November): 

  • Couldn't run a mile without HR spiking, chest pain

  • Running felt wrong - not hard, WRONG

  • Still not sleeping

  • felt like I couldn't function at anything - just incredibly deep fatigue

  • All the weird symptoms:

    • Sleep: 4-5 hours max, waking at 3am wide awake

    • Running: chest pain, inappropriately high HR, zero uphill strength

    • Energy: never wanted to get out of bed, zero motivation

    • Mental: mood crashes, hard to shake off depressed feeling

    • Autonomic dysfunction: lightheaded when standing, horrible temperature regulation, waking up drenched in sweat (like hot flashes), always cold otherwise

    • no libido

    • Weight gain

    • Just felt like my body was broken

    • Lost trust in my body, which has taken a long time to repair

  • Self-diagnosed in July/August based on research and blood work

  • Had my Mirena removed to see if I was cycling (came back normally Sept 2024)

  • High cholesterol-  abnormal for endurance athlete

  • Low ferritin despite supplementing

  • Elevated prediabetic markers A1C, fasting glucose in an endurance athlete

  • Low estradiol

  • Low progesterone 

  • Low FSH 

  • I had heard something about high cholesterol being a sign of underfueling in athletes and thank god I did because all the doctors were indicating that I should eat less processed foods→ the great paradox of athletic healthcare!

  • Started eating more!

  • Had to force it at first

  • Focused on rest for 3 weeks

  • I didn't feel any better. My sleep stayed the same. Not a single night over 5 hours.

  • Gained 15 lbs in the next few months which actually felt pretty horrible, ngl

  • Stage 3: Messy pseudo-recovery:

  • Focused on rest, but runs still felt horrible

  • Started having a few decent runs in October

  • "Thought maybe I was turning a corner"

  • Started building back: 20 miles/week, adding 5 miles/week

  • Moved to part-time with my job

  • A note on weight gain:

    • Gained ~15 lbs over next few months

    • I tried to tell myself it was good, it was healing, but running felt harder and I felt uncomfortable in my skin

    • The psychological battle was tough

  • The second, hardest crash:

  • One good run, then the next week: horrible again

  • High HR, chest pain, leg heaviness, still terrible sleep

  • Travel for weddings + trying to train = backfire

  • Worst depression I'd ever experienced

  • I could barely move, had no energy

  • Turning point:

    • My mom (as a doctor) recognized the mental health crisis

    • Got on medication for the first time

    • Finally started sleeping better and that unlocked my ability to finally start making bits of progress→ routine, energy, better mental state.

  • Building back (December 2024 - April 2025):

  • Sleep → energy → ability to build routine again

  • Solo trip to reconnect to my why

  • Started training for marathon, but running never felt as effortless and free as it used to

  • Many days where I had to completely change the plan

  • Learning flexibility: more easy days, less mileage focus, more cross-training

  • Marathon in May: 2:58, close to PR and proud of what I accomplished

  • But I still didn't feel 'good' - it was a feeling. Running felt hard and tiring, my body felt bloated and uncomfortable

  • Stage 3 summary: "This is the part that’s very hard - you're doing the 'right thing' but you don't feel better. You feel worse in different ways. And I was 'recovered enough' to perform but not actually recovered. Performance ≠ health."

- Stage 4: Rebuilding differently for UTMB (May - August 2025) 

Training felt mentally invigorating but physically tough

  • No uphill strength

  • Lifting would really wear me out

  • Everything harder to recover from

  • Sleep suffered whenever I pushed harder

  • Good days were much fewer and farther between

Learning a new approach:

  • More flexibility while still holding myself accountable

  • More easy days, more rest days

  • Trying new training methods

  • Rebuilding self-belief while accepting different fitness

  • "I had to grieve who I thought I should be"

UTMB decision:

  • Reframed goals: less performance, more about experience

  • Being with my family, reconnecting to broader why

  • Got back on medication 2 weeks before for sleep

  • "This was a calculated decision - I knew I wasn't 100%, but this mattered to me"

Stage 4 summary: I chose to work with my body toward a goal that mattered to me, and I stand by that. But I also don’t confuse that with real recovery.

  • Stage 5: The 3-month break:

  • First real break since 2020

  • Mentally hard: "endorphins and structure are huge for my mental health"

  • But physically: almost immediate changes

What happened:

  • Started sleeping through the night consistently

  • Lost ~10 lbs (bloat disappeared) - naturally, without restriction

  • Running felt smooth and enjoyable again

  • Started to feel like my old self– natural energy in the morning, running enjoyment, etc. 

The biomarkers confirmed it:

  • Cholesterol normalized

  • Ferritin way up

  • Estrogen higher

  • Leptin increased

  • Prediabetic markers resolved

Stage 5 summary: My body needed permission to truly rest. Not rest while training 'easy.' Not rest with an agenda. Just actual rest. 

LESSONS LEARNED

1. Warning signs (physical & behavioral):

Physical:

  • Persistent sleep disruption

  • Running feeling "wrong" not just hard

  • Loss of period or irregular cycles

  • poor temperature regulation

  • Lightheadedness, blacking out when standing

  • Night sweats, hot flashes

  • Loss of libido

  • Persistent fatigue or consistent lack of energy

  • Loss of appetite when should be hungry OR hungry all the time

  • Waking up hungry

Behavioral/psychological:

  • Zero motivation, not wanting to get out of bed

  • Depression that seems out of proportion

  • Loss of joy in the sport

2. Blood tests to get:

  • Complete metabolic panel

  • Lipid panel - high cholesterol in endurance athlete = yellow flag

  • Thyroid (TSH, Free T3, Free T4)

  • Iron studies (ferritin, serum iron, TIBC)

  • Female hormones at appropriate cycle phase (estradiol, progesterone, LH, FSH)

  • Leptin - energy availability marker 

  • Metabolic markers (fasting glucose, HbA1c, fasting insulin) - prediabetic markers in athlete = yellow flag

  • Vitamin D

  • Cortisol

  • Complete blood count

Important caveat: Some markers can be normal in some contexts and abnormal in others. I was trying to piece together a puzzle. Every story is different. Find a doctor who understands the athletic context. 

3. All stress is stress:

  • Physical + emotional stressors compound

  • Life stress counts in training load

  • Major life events require reducing volume

4. Weight gain nuance:

  • Necessary for recovery - body restoring what it needs

  • Also really psychologically hard

  • It's okay to simultaneously accept it's necessary AND want to get back to where you were

  • The key is patience and working WITH your body

  • When I truly rested, my body rebalanced naturally

5. Rest is non-negotiable:

  • RESTING is what actually healed me

  • Life rest plus training rest

6. Mental health IS physical health:

  • Depression wasn't weakness - it was physiological, but I compounded it by being so hard on myself

  • Hormonal issues from REDs or overtraining affects mood regulation

  • Chronic sleep deprivation affects everything

  • You can't therapy your way out of a hormonal crisis

  • Medication gave me sleep → sleep gave me energy → energy let me rebuild. Do what you need to get the healing cycle going. 

7. Radical honesty:

  • With yourself

  • With your support system

  • High achievers are good at normalizing dysfunction

  • The shame around “I should be able to just tough this out” because that’s what athletes do

8. Timeline expectations:

  • Performance ≠ health

  • I PR'd a marathon while still struggling

  • I finished UTMB while not recovered

  • The recovered “feeling” I was looking for came from rest, not achievement

  • Perhaps could have been faster if I rested earlier, but who knows

Gratitude: would not have made it through without my support system, and wish I had been even more honest with myself, and therefore others, about how hard it was. I felt like it was hard to talk about in the running community because, well, everyone was running. 

What I would have told myself in May 2024: 

  • Your body is already vulnerable

  • Grief is real physiological stress

  • Canyons 100 was not the cause, but the acute stressor I couldn’t recover from

  • You can't outsmart this

  • True rest means nothing for longer than feels comfortable

  • It’s ok to get help→ medication, external support, time off from work, etc. 

What you'd tell someone recognizing themselves:

  • Get the blood work - be specific about what you request

  • Find doctors who understand REDs

  • You might need medication - that's okay

  • The weight gain is necessary - your body will rebalance when it feels safe

  • True rest is the only way through

  • It takes longer than you think

  • You will feel like yourself again

Related Episodes:

Link to episode outreach and feedback form: https://docs.google.com/forms/d/e/1FAIpQLSfurpk5exg6eYh-0KBxGMoZZvEKb_UA440EGlX9ypfn7mK0mw/viewform?usp=publish-editor

Challenge of the week:

Elena: Be really honest with yourself about how you’re feeling. Ask why 5x.

Katie: To build on the above - journal it, then have a conversation about it with someone you trust! Can be helpful to have an outside perspective

Gear or resource pick of the week:

Elena: Macro bars? Is that lame? And would love to crowdsource go-to snack ideas.

Katie: Rally app (+ quick anecdote from an athlete)

Jim Anderson
Next

Episode 112: Lessons from 2025!