Episode 131: Racing Accessibility for New Moms, Triaging Persistent Fatigue, and the “Why Not You?” Mantra
In this week’s episode, we start by diving into one of the biggest endurance stories of the year: Rachel Entrekin’s historic overall win and course record at Cocodona 250, using it as a springboard to discuss confidence, self-belief, fueling, and the evolving landscape of women’s sport. We unpack the mental strategies behind big performances, including Rachel’s “why not you” mantra, and reflect on how visibility in sport can inspire the next generation. Katie also shares the realities of returning to racing postpartum, the barriers new moms still face in endurance sport, and how she’s pushing for better accessibility and support at races. Finally, we close with a practical deep dive on fatigue in endurance athletes: low energy availability, RED-S, bloodwork, cortisol, ferritin, fueling mistakes, and how to actually troubleshoot persistent fatigue when something feels off. Check it out!
Check out our form on racing accessibility for moms here: https://forms.gle/kLAVS6NtzJwYA7z27
Links/resources we mentioned
How Rachel Entrekin Led a ‘Paradigm Shift’ and Became the First Woman to Win Cocodona 250 Outright articleTriaging fatigue:
Fatigue is something every endurance athlete deals with — and it gets dismissed constantly
"You're training hard, you're tired, that's normal" — sometimes true, sometimes not
Important framing first: if you're experiencing persistent fatigue, the first response is always rest — that doesn't change regardless of what any blood test says
This is meant to be information rather than diagnosis
Introducing the HPA Axis:
Before getting into the triage framework, it helps to understand why all of these things tend to go wrong at the same time
The HPA axis — hypothalamic-pituitary-adrenal — is the body's central stress response system
The hypothalamus signals the pituitary, which signals the adrenal glands to produce cortisol
Cortisol is the body's primary stress hormone — it mobilizes energy, regulates immune function, and prepares you for demand
Under normal circumstances it follows a predictable daily pattern — peaks sharply in the morning, drops through the day, lowest at night
The HPA axis doesn't just respond to training stress — it processes all stress through the same circuitry
Training load, poor sleep, life demands, and insufficient fuel all register as the same signal: the environment is demanding and resources are scarce
Allostatic load is the cumulative cost of that chronic demand on the body's regulatory systems
Acute stress is fine — the system responds, recovers, adapts. That's training.
Chronic unresolved stress is where the problems start — the system stays activated, begins to strain, and eventually starts to downregulate
The HPA axis is deeply interconnected with every other system in the body
When it's under chronic strain, it doesn't just affect cortisol — it suppresses the reproductive axis, downregulates thyroid output, disrupts immune function, affects iron metabolism
So when we talk about triaging fatigue today — the framework we're working through is really asking: where is this system under strain, and what's driving it? Information not diagnosis!
Four areas to investigate — work through in order
Quick caveat: there are other potential drivers — sleep disorders, autoimmune conditions, mental health — worth exploring with a provider if these foundational areas come back clean. This is a starting point, not an exhaustive list.
Underfueling
Most common, most missed
When present it drives everything else — low iron, suppressed thyroid, disrupted hormones can all be downstream of not eating enough, not independent problems
Doesn't require intentional restriction — high training loads, suppressed appetite, busy life, the gap opens quietly
Nutrient deficiencies
If intake looks adequate, next layer is what's depleted
Ferritin is the biggest one — standard labs miss it until it's critically low
Vitamin D, B12, magnesium also directly drive fatigue and are commonly depleted in training athletes
Thyroid and stress response
Thyroid downregulates under chronic energy deficit or high stress — even when standard tests look normal
Cortisol tells a related story — too high or too blunted both signal a stressed system
Hormonal disruption
Often a consequence of upstream issues, not an independent cause
Testing hormones before addressing foundational layers often produces confusing results — which is why they come last
The thread connecting all of it
Allostatic load — cumulative cost of chronic stress, where stress means training, life, poor sleep, and insufficient fuel all drawing from the same well
Before you order any labs — two free steps first
Start a symptom log
Write down daily: energy, mood, sleep, motivation to train, any physical symptoms
Two weeks of data turns invisible patterns into obvious ones
Free template at coralta.co
Estimate energy availability and try eating more
EA = (Calories In − Exercise Calories) ÷ Fat Free Mass in kg
Rough estimate is enough — looking for whether you're in the right ballpark
≥45 kcal/kg FFM adequate / 30–44 suboptimal / below 30 significant
Before touching a blood test: genuinely try eating more for two weeks, especially carbohydrates around training
If things start shifting — energy, mood, performance — real signal
If nothing changes, that's signal too — time to go deeper
The blood testing framework
Two phases — ordering everything at once creates noise and makes results harder to interpret
Key framing: standard lab ranges are built on general population data, not people training seriously — a green flag on your lab report may still be suboptimal for an athlete
Phase 1 — foundational markers, start here
Ferritin, serum iron, TIBC — optimal for endurance athletes 50–100 ng/mL, labs flag low at 12 — that gap is the whole problem
CBC — hemoglobin and red blood cell health, screens for anemia
TSH, Free T3, Free T4 — full thyroid picture, TSH alone misses a lot
Vitamin D — optimal 50–80 ng/mL, most labs flag below 30
B12 — especially relevant if plant-based
RBC magnesium — not serum magnesium, too tightly regulated to be useful
Morning cortisol — fasting, 7–9am, snapshot of the stress response system (looking for at least over 10 ng/mL)
Fasting glucose and insulin — metabolic baseline
hs-CRP — inflammation marker, useful signal for under-recovery or overtraining
Lipid panel — underfueling affects lipid metabolism in ways that often get missed
Phase 2 — hormonal panel, only if Phase 1 is largely clean
Estradiol, progesterone, LH, FSH — timing within the cycle matters enormously for interpretation
Reverse T3 if Free T3 was flagged low
Salivary 4-point cortisol if morning serum was off or symptom picture suggests HPA dysregulation
What to do with results
Information, not diagnosis — the goal is to understand what your body is doing and come to your doctor with better data
If something is flagged, it's not a replacement for rest — it's additional context for why rest and likely fueling changes matter
Persistent fatigue is a signal worth taking seriously
Challenge of the week
Katie: Regular bloodwork! Learned a few things recently that can help me be extra proactive going forward
Elena: Sign up for a low stakes local race!
Gear or resource pick of the week
Katie: WHSP in Boston
Elena: Elite Sleep by Momentousand The Dark Wizard docuseries on HBOHow Rachel Entrekin Led a ‘Paradigm Shift’ and Became the First Woman to Win Cocodona 250 Outright