You know how hard it can be to explain personal problems to your dad sometimes? Well it turns out it’s even harder to explain it in a public setting. Especially in the written form online, because we all know, anything that gets posted online never really disappears! Having been working through some health issues, which have gradually transformed or been revealed to be part of much more general issues of my relationship with myself, I have been unsure of where I’m at, where I’m going and how I got here. That sounds a lot like being lost. But perhaps it’s more about exploring – maybe even an adventure? A great conversation with a relative of mine recently introduced the idea that a series of events could be put together to tell a number of different stories – it’s a simple concept but not one that’s always obvious when we’re dealing with the subjective nature of our own experiences.
I’ve also been thinking about the nature of sharing and blogging. It’s actually really difficult to share your life publicly in real time, it introduces risk. I’ve been told I am a perfectionist – in the past I thought this was a positive attribute but now I understand it as being more unhelpful than helpful. Shaking off perfectionist thinking is a work in progress and one things that is certain is that perfectionists do not like risks. So in the world of real-time blogging and social media updates, how many bloggers actually take risks and open themselves up to failure, versus waiting for whatever project or event they’re engaged in to conclude successfully before sharing it with the world? I feel like I’ve occasionally taken risks and shared life and work in-progress, but I’ll admit, it was uncomfortable and I don’t do it very often.
But my health issues have led to me thinking about all of this in a completely different way. I feel like I have a moral obligation to take risks and share things that could go wrong, go nowhere or that are even already going wrong! And this feels like a much stronger motivator than the fear of people seeing things go wrong. I listened to the Fearless Rebelle Radio podcast last week which interviewed Kelly Diels. Kelly describes herself as a ‘feminist marketing consultant’; I spent about a decade working in marketing and thought, ‘those are two words you don’t often hear in the same sentence,’ so I sat up and listened. And once I’d listened to the podcast once through, I pulled out my notebook and pen (old school!) and listened again. It was that pithy and important to me! I have been influenced by lots of great books, podcasts and YouTube videos over the last year (more details below), but listening to Kelly speak and reading some of her articles has made sense of some problems that I have been grappling over the last few months with when it comes to being a fitness professional in an industry that (mostly) trades on making people feel bad about themselves.
How do you even talk about fitness and healthy eating without inadvertently supporting the general idea that everyone look and behave a certain way and sounding, at best, like someone who is appropriating messages of empowerment and a positive body image and, at worst, like you are preying on (and adding to) people’s insecurities? Part of me wants to delete a lot of my previous blog articles in an act of cleansing and purifying. But perhaps they serve to make the change of emphasis more powerful – after all, perfectionism and censorship is out, right? In any case, I’m going to strive to not conform to the archetype of the ‘female lifestyle empowerment brand’ that Kelly describes, by trying to share the s***t along with the successes, perhaps by judging things in a less dichotomous success-or-failure sort of way and call out the systems that are responsible for taking our self-confidence and selling it back to us (usually without actually delivering).
So what personal problem did I share with my dad and how did it bring me to a radical change of direction? As I’ve shared this with more people from different parts of my life and got to know many other people who have suffered with it, it seems most silly to make a big deal out of it, but telling my dad about it seemed like a real milestone. And you know what, he was patient, supportive and non-judgemental. He was actually sort of impressed by the way I’d recognised it and dealt with it, largely under my own steam. He also intuitively understood I should share it with others and is the last person I told. So here it is.
I had a problem known variously as Relative Energy Deficiency in Sport (RED-S), the Female Athlete Triad (with the ironic acronym, FAT), hypothalamic amenorrhea (HA), over-exercise and disordered eating. The most obvious symptom was missing periods, but that’s only a small part of the problem. I’ll stop short at calling it an eating disorder – over-exercise can be a type of bulimia, although I’m not entirely sure I fit into that category and would hate to make light what people with a true eating disorder go through. I operated with a significant calorie deficit for years while cycling an hour each day to-and-from work along with additional swim, bike or run workouts most days and struggled to consume enough calories on my vegetarian, gluten and dairy-free diet. I don’t believe I consciously tried to restrict my energy intake (most of the time anyway), but after following some fairly extreme diets in my early twenties (guided by qualified healthcare professionals I might add) to try to overcome serious gut symptoms and other issues, it was hard not to have some residual ‘food phobia’. I was aware for a while that I found it difficult to eat enough energy to maintain my weight and constantly felt hungry. I admit that I became obsessed with my weight – not with making it as low as possible, I knew I needed to stop it from dropping ‘too low’ to say ‘healthy’, but I didn’t really want it to go up either.
Getting fit and taking part in endurance sport made me feel great in so many ways, but the signs that something was wrong started at least 5 years ago. However, those signs seemed unconnected from my eating and exercise habits and none bothered me enough to pay much attention so I carried on pursuing what I enjoyed doing and what felt rewarding. It wasn’t until I stopped taking the pill that I suspected there might be a problem. I waited 3 months, no period. I went to the doctor, no problem they said, it’s normal after stopping the pill, have a blood test and come back after 6 months. 6 months passed, I went back. It’s not uncommon for it to take 6 months I was told, have another blood test and come back after 12 months. All this time I felt so embarrassed I breathed a word to almost no-one and on the rare occasions that the subject of periods came up when I was with other women, I felt so awkward not feeling like I could relate to them but couldn’t say why.
For the most part, however, nothing was really happening and it was easy to put missing periods to the back of my mind and get on with life. Changes to my work schedule meant that I was no longer able to take part in group training sessions with my triathlon club and I knew I’d need to start doing most of my training alone. I had a goal of racing Xterra and knew precious little about off-road triathlon so I sought a coach to help me who did. When I first started working with Louise, I told her about my amenorrhea and progress (or lack thereof) with my doctor, and she insisted on me providing a letter from my doctor to say it was okay to pursue triathlon training. My doctor, seemingly completely in denial (or ignorance) that my training had anything to do with it, willingly obliged and so Louise started designing me a gradual programme to build base fitness and establish a new routine and regularly checked-in on my health as things progressed. She also encouraged me to gain a bit of weight, which I did, although it wasn’t that much and it was hard to hang on to as the training volume ramped up.
After over a year without a period, I went back to the doctor who sent me for yet more blood tests and an ultrasound scan. All seemed normal, according to my GP, but they agreed to send me to an Endocrinologist. While waiting for the appointment to come through (I had a 3 month wait), I came across a new book called ‘No Period Now What?’ (referred to below as NPNW). I was intrigued, bought a downloadable copy and devoured the first half of the book in one sitting. I went back to my GP and obtained my blood test results and compared with the figures in the book. I had heard of secondary amenorrhea as a result of low energy-availability at a British Triathlon (BTF) coaches nutrition seminar that introduced the RED-S framework a year before, but I didn’t think (or want to believe) that it applied to me. When I read NPNW and saw the list of other symptoms and side-effects, combined with comparing my hormone counts from my blood tests with the typical figures listed in the book, I realised I had a full-blown case of Hypothalamic Amenorrhea. I knew from the BTF seminar that allowing it to go on risked osteopenia and increased the likelihood of osteoporosis but I also discovered that because HA is similar to the menopause, it is very likely that, like the menopause it also increases the likelihood of neurodegenerative disease and cardiac disease. But unlike the menopause I would be exposing myself to these risks 10-20 years early. And of course there is the temporary and potentially permanent infertility alongside all the other side effects that I had been ignoring for so long.
I knew I had to do something about it, so I followed the instructions in the book; simple enough, but of course I tried to find ways to complicate it. Exercise as little as possible, do not restrict food in any way, eat at least 3000 calories a day and make sure there are lots of carbs. Exercise as little as possible – I asked my coach, does that mean I can run just 5 times per week as long as I keep it to half an hour? Knowing about RED-S and that I had been referred to an endocrinologist, she sagely declined to reply. I realised my question was from a slightly exercise-obsessed mindset and I needed to let go. I didn’t sit totally still while I was recovering, there was the occasional bike ride, I coached indoor-cycling classes keeping my heart-rate low and I occasionally ran for less than half an hour or went for easy swims focussed on technique. And I also kept my personal training appointments and Our Parks classes going, which involved cycling to the appointments and exercise demonstrations. But it was drastically less than I had been doing, and there was absolutely no hint of ‘progressive overload’ that is normally associated with training.
My period came back within 2 months and I was so excited I felt like I could hardly stop myself from telling everyone I saw! I continued the protocol of minimal exercise and plenty of eating for 3 cycles and just after the 4th I cautiously went back to more structured training, under the guidance of my coach. I tried to listen carefully for signs of my body regressing, I started measuring my heart-rate variability (a new tech trend in endurance sports – I’m not sure how much I learned from it other than life stress seems to affect me way more than exercise), my basal body temperature and just generally tried to take note of anything that diverged from feeling good. I had lots of moments of doubt and took an ‘if in doubt, leave it out’ approach to training, so it felt like I was skipping stuff left-right-and-centre. I was desperate to believe I could still take part in endurance sports and be healthy, if I did it right and there was a race coming up right on my doorstep with discounted entry. Not on my home doorstep, admittedly, but just a stone’s throw from the hotel we’d booked for the triathlon club training camp in Italy.
There was a choice of sprint or middle-distance races. I didn’t think the sprint represented much of a test of my abilities (so arrogant!) so I tentatively entered the middle distance race. I’ve done the distance a few times before, and figured I could follow a low-volume training approach and just take the race steady on the day, no pressure for a fast time. I don’t want to make this a race report, but suffice to say it went okay. The result was actually pretty amazing, all things considered, and on a par with past results when I was at my lowest weight and height of HA. But I’d felt compelled to spend a lot of the triathlon training camp ‘on the bench’ so to speak, doing relatively minimal amount of swim, bike and run. I was having a lie-in when my wonderful yet slightly hyperactive group of friends were diving into the sea in their wetsuits just after the sun had come up and I tried to be cheerful waving them off as they set off to explore the hills of Emilia Romagna on two wheels. I knew that packing in over 500km of swimming, cycling and running during a week was probably going to be bad for me, although at the same time I realised I’d somehow managed to substitute the fun, carefree, social side of the sport for the serious business of race tapering and saving myself for a self-designated ‘day of reckoning’.
That was about a month ago now. I’m coming to the conclusion that my body didn’t cope all that well with the training, even though it was meant to be minimal. Things didn’t go drastically wrong, but my weight fluctuated a bit (I have only a vague sense of this as I’m trying to weigh myself once a month at most) and there were changes to my cycle so I know my hypothalamus didn’t approve. I know that I didn’t do as well with the fuelling as I would have liked, as when I was in some of the highest-volume training weeks and busy juggling work and training I definitely become a ‘chaotic unconscious eater’ (one of the eating personalities described in Evelyn Tribole and Elyse Resch’s ‘Intuitive Eating’), focused on packing in calories and nutritious foods but in a really unstructured way. Would a more structured eating pattern with more time for meals solve the problem? Possibly. But I think it’s a relatively slim chance and I’d need to hardly take on any work to find out. Perhaps my body just needs more time. There’s only one of me and it’s quite an individual thing, so it will always be hard to know for sure. I’m not sure what my participation in endurance sports will look like going forwards, it’s really a process of trial and error and it’s going to take a long time to work out the ideal balance, if such a thing exists.
That brings me to pulling all this together and putting the new philosophy into practise. Now I’ve got this stuff on the table and there is some context to it all, I’m going to start doing things differently. I pledge to:
- Call out b***s*** about diet and exercise! I don’t want to be a troll and there is too much crap out there to police it all, but I’m going to try to call the paradigm into question, hopefully in a constructive way (*I reserve the right to occasionally substitute “constructive” with “really angry”).
- Put myself on the line, show that I’m not perfect (in case there was ever any illusion!), be prepared to let others see me ‘fail’ and take risks – I’ll start this right now by revealing that I’ve started writing a book. I’ve already got about 7,000 words which came out in a couple of days. When I was putting together this post, it felt like I could put it in the centre of a spider diagram as there were so many off-shoots, sub-stories and concepts to explore and share and it feels like this piece begs lots of questions which will take long answers. Unexpectedly, the words I’ve put down so far contain a lot of teenage angst and I’m not sure if anyone really wants to read that! I guess I’ll just keep it flowing for now and then evaluate what I’ve got when it’s all come out (that sounds like being really ill!)
- Participate in and acknowledge the wider community of people with similar stories and shared beliefs. I will start by acknowledging and thanking all the people that have done or said things that changed the path of this story. This seems like some kind of overly dramatic Oscar speech thank you list, but I am genuinely so grateful to all of these people so I’m including them all anyway, in rough chronological order:
- Triathlon England and GSK Human Performance Lab: Jon Train and Audrey Livingston who organise the coaching education programme at for putting on the great nutrition seminars at Triathlon England: London Region, for arranging the nutrition seminar at GSK Human Performance lab where I first learned about the FAT and RED-S; Dame Kelly Holmes and Ana Anton at GSK HPL for their detailed and frank presentations on the subject
- Nicola Rinaldi for her book No Period Now What? which was pivotal to me properly understanding what was happening and how to recover, as well as for starting and regularly contributing to the recovery support groups on facebook which have been a big help mentally.
- My coach, Louise Hanley, for making me finally take the leap, stop training and focus on recovering. And for taking me back and encouraging me after I had!
- Sophie Kay (thefitologyway.com) for reassuring me that other personal trainers have their doubts about the fitness industry and taking time out of her schedule to listen to me sob about it!
- Jill Puleo (acaseofthejills.com) for bravely undertaking her own journey through HA, telling her story on YouTube, tackling the sometimes controversial question of how and when to go back to exercise and for the long and supportive emails back and forth – you are so inspirational!
- All the coaches at London Fields Triathlon Club – who are mostly men – for being some of the first to hear about my dysfunctional ovaries. I was, and still am, concerned about other athletes in my club unknowingly suffering from the same problem that making the coaching team aware of the issue was one of my first priorities. They took it very seriously and I’m so grateful as it wasn’t my easiest speaking gig, even though I know them all really well! A special mention goes to Karl Grainger for helping me to kick off a research project looking at the issue, which involved explaining it to nineteen-year old male BSc Sports Science students at London Met (poor them)! Excited to see how the project goes…
- My favourite anti-diet and pro body-positivity (or neutrality) podcasters, Meret Boxler of Life. Unrestricted and Summer Innanen of Fearless Rebelle Radio. I can’t tell you how much the interviews I’ve listened to have educated me on the wider issues and positively influenced my mindset.
- My sister for being so understanding and supportive since telling her about the problem and for proofreading this and telling me I should give my dad another shoutout. He’s stealing all the limelight lately!
I’m aware that some of the concepts I’ve put forward here will be hard for some people to accept – after all, we live in a world where 26% of adults take less than than 30 minutes physical activity a week, only 61% of adults manage the recommended 150 minutes or more a week and 74% of adults eat less than 5 portions of fruit and vegetables per day*. The idea that too much exercise can be bad for you is taboo. But it also means that the message of moderation is not being heard loudly enough amidst the din of the official health recommendations, the fitness and fashion industries (yep, just google ‘athleisure sector’), traditional and social media. I have no intention of becoming a couch potato, I’m just going to spend a bit more time contentedly occupying the middle ground and defending my place there with a truckload of research and personal insight.
If you have been affected by any of the issues I’ve touched on here, please comment (you can do so anonymously!), send me an email, speak to your doctor, your coach or someone you trust. I’d also encourage you to make use of the links and resources I’ve signposted.
With love and respect, Abby x
*Data from the report “The Statistics on Obesity, Physical Activity and Diet – England 2017” published by NHS Digital.