My immunity used to be dreadful. Working in a hospital I am constantly exposed to a variety of bugs so in my first few years as a junior doctor, when I was run ragged working full time and trying to run 90-100 mile weeks, I caught it all. Probably best there wasn’t a global pandemic at that stage.

When I started training hard and running lots of miles I didn’t appreciate the importance of protecting my immune system and spent at least a year with illness after illness.

One of my first England vests was in Leeds to run the 10km. The days before I left I was working on a medical ward with an outbreak of norovirus (winter vomiting bug). When I arrived at the hotel I felt a bit iffy but thought “probably just nerves” the next day maybe felt a little worse but it wasn’t until I started that I realised something was not right then a mile in dropped into a heap on the side of the road.

It was mortifying, especially wearing my England kit and feeling like I had let the team down. It took more than 10 hours to drive back home to Cornwall, incredibly bleak. Needless to say, I never shared the grapes in the Doctor’s office again (wrapped quality street choccie remains ok though).

A learning curve 

Over the years I have read lots of research and sought professional advice on how better to look after my immune system. As runners, getting ill is rather inconvenient. It means setbacks in training, missing races, increasing injury risk etc etc.

So I thought for my first Fast10 blog I’d share a bit about my experience and how I’ve managed to support my immune system the best I can. I’m by no means an expert but I am a doctor with a particular personal interest in avoiding infections as an athlete. Plus I must be doing something right as I’ve survived a year working on and off covid wards illness free!

If I’m honest I kind of hope this level of PPE stays in the hospital, infection outbreaks seem to come at the worst possible times. Before my wedding there was a Norovirus outbreak on the ward and before my last marathon a flu outbreak. As if marathonoia isn’t enough, a week of exposure to flu is less than ideal a week out from a marathon.

A bit of luck and maybe a more experienced approach on both occasions meant no D+V for my wedding and no flu running, so a huge PB of 2.33. 

Burning the candle at both ends

A big turning point for me was cutting my work to part time. I used to have the mentality that what doesn’t kill you makes you stronger, I even go as far as saying I got a kick out of flogging myself both at work and in training.

But I was constantly knackered. I dread to think what my cortisol levels were during that time.

Needless to say it did come crashing down as after a year of constant illnesses, culminating with my first stress fracture. Since working part time (still roughly 30 hours a week) I have time to do all the extra bits that are important, rest, mobility. Small changes, like not having to eat my lunch at 5pm in a cupboard on the ward quickly.

Goes without saying my stress levels plummeted too and stress can be another negative factor to health. I also just feel like a better doctor and runner. I’m able to give my patients a better version of myself and I am able to enjoy my running instead of fighting to keep my head above water. 

40 winks for the win

The value placed on sleep, both duration and quality of, is something that has changed too. Sleep is restorative and it’s when your immune function is at its best and our bodies repair. I read a book last year called “Why we sleep” by the sleep scientist Matthew Walker.

It’s so interesting and there is lots of eye opening research out there. The advice is at least 8 hours a night but athletes tend to need more than this. I normally aim for 9-10 and if I’m unable for any reason try and find a window to nap.

Also probably important to mention I used to be a bit of a boozer too, medical students have a bit of a reputation for this. Don’t get me wrong, I still love a nice cold beer or glass of wine of an evening but moderation is key here. Boozing too much has negative effects on sleep and hydration, hence affecting ability to recover. 

Variety and balance with your food

Before meeting my wife there was always the same three meals on rotation. Fast forward to now and it’s a much more well-balanced, varied diet and it makes a big difference. I still treat myself to pizzas and takeaways but in-between those we enjoy cooking new recipes, with fresh ingredients and it feels like we’re getting more of the vitamins and minerals, and calories, I need.

This includes iron, vitamin c, magnesium as some of the key things to include that might have been lacking in the past, when my diet was a little less… interesting.

Cooking foods with fresh ingredients, from scratch where possible, will help keep things nutrient rich. In addition, after getting some advice from the well-known and brilliant sports dietician Renee Mccgregor I also started taking some probiotics.

It feels like the amount of upper respiratory tract infections I got halved and went from getting three colds a year to one at most. This is obviously anecdotal and could have been coincidence but there is a lot of evidence behind gut health and immunity which is beyond this little blog so I will leave it to the experts and for you to read up on at your leisure.  

Help your body do it’s job

That being said, all of the above is good for general illness avoidance but it is by no means a bullet proof way to protect yourself from Covid (There was certainly some luck involved for me there).

The closest  you will get to that is the vaccine, so a quick note on vaccines, I made sure I had good night’s kip after it for a few days, you want to get the best immune response possible and like I said most of this is when we sleep. I also avoided training hard for a few days to give my body chance to focus on the job at hand! 

I hope this is of help to some people, it’s nothing ground breaking but it took me a long time to start properly looking after myself and we’re all still learning.

The post Staying healthy as a doctor and a runner appeared first on Fast Running.

Dedication is a powerful trait and there is nothing wrong with being so committed to something you want to do your utmost to succeed at it. It is a wonderful thing to possess until it becomes destructive, as it did for me.

When dedication overrides rational it can become dangerous. This is when you can’t stop yourself from always doing more. You always go that one step further and still look for other areas to show ‘more dedication’.

When applied to your goals in athletics, it can lead you down a path where you severely overdo things, and you can find yourself either overtraining, underfueling or both. At this moment you have no idea that what you are doing is destroying your body and your health.

This is the point I have reached in the past. I was willing to starve myself due to the belief it would make me a faster, and a better athlete. To show that I was so dedicated to my sport that I was willing to deny myself the food I needed.

I thought it was the right thing to do, IT ISN’T! Not only was I so determined to deny myself food, but I was also willing to run through unbearable pain, all because I believed it would help me succeed.

But, it DIDN’T, it only pushed me backwards. Dedication is a wonderful thing, but not when you start destroying yourself.

I now look back and see how dangerous this was and I want to do my utmost to help others to become aware of the point at which dedication becomes destructive.

More people need to be aware of the dangers of not fueling yourself properly, and that the concept, ‘thinner equals faster’ couldn’t be further from the truth. Don’t make the same mistakes I did!

How did it start?

The first thing that sparked my downward spiral, was when I decided I needed to eat less if I wanted to be a faster runner. THIS IS NOT TRUE. IT DOESN’T WORK.

I began comparing myself to other runners around me; believing that I needed to shed weight… weight that I didn’t have to lose. I felt that if I wanted to be a serious runner, I needed to be skin and bones.

I forgot about the muscle aspect. I became caught up in this vicious cycle of wanting to lose more and more weight. This was weight that I couldn’t afford to lose. My dedication was now destroying my running, and me.

It’s a vicious cycle

As time went on, stress began to take over. Friendship groups began to split up, the stress of exams arose, my mum fell ill, and I lost one of my best friends. The only thing I had control over, was food.

Due to being too weak, my running was suffering, and controlling my intake was the only thing I was good at. I looked at every aspect of my diet I could cut back on. I began restricting vital nutrients, particularly calcium. It was as if I was competing against myself. I had lost sight of wanting to succeed as a runner, and I was constantly looking to where I could cut more out.

As the stresses of life amounted, restricting my intake became a sort of safety blanket. I felt proud the less I ate, like I was succeeding. But what really was I succeeding at?

I was starving myself, I had no energy, and quite frankly I was an atrocious runner because of it. The less I ate, the worse I ran, the more I punished myself. It became a vicious cycle.

I was trying to eat as little as possible, whilst trying to train like a serious athlete. Not a formula for success. My friends and family noticed what was going on, but I didn’t see it. I was ignorant to the damage I was doing.

Sufficient fuel is vital

At the lowest of my lows, I turned up to a training session with my coach, fueled off next to nothing, and couldn’t finish the session. We were doing interval reps round a football pitch, and I was unable to complete three reps of half a pitch. I had no energy, and I was weak.

My body simply didn’t have the fuel it needed to do what I was asking of it. I looked at myself, I had lost sight of my goals. There was no way I could even complete an easy run without a struggle. There was nothing to be gained by doing this, only lost. Not only was I wasting my coach’s time, but I was also wasting my own.

I won’t deny that it was hard to break the cycle. It was difficult to recognise that malnourishment was dangerous. I would need more than two hands to count the number of times I told myself that I was going to change, but no matter how long it takes, keep telling yourself, because it will eventually pay off.

I finally saw that if I could use my determination to my advantage, and make being healthy my goal, I could see food as my friend once again. I learnt to use my powerful mindset to my benefit, rather than in a destructive way.

One thing I never lost sight of was my desire to be a strong, healthy runner. I wanted to be taken seriously.

Looking back

This was not healthy and it was not a sign of dedication. Looking back at myself, I have no comprehension of why I let myself get caught up in such a dangerous game. Running was, and finally is once again, one of the most important things in my life outside of my friends and family.

I was so close to losing it and will never go back there. There is a distinct difference between dedication and destruction. Dedication is powerful, use that power wisely, don’t destroy yourself because of it.

Lighter doesn’t mean faster but being healthy does! Nothing positive comes out of starving yourself, it only leads to complications down the line.

I have finally realised if I can use that dedication and determination in a positive way, who knows what can be achieved. If this is something you have struggled with, or still are struggling with, don’t be afraid to talk about it. It is the only way we can educate each other.

Hannah Irwin features in the ‘Fast 10: class of 2019’ and over the course of the year will share her running journey. You can follow Hannah on Instagram, while further information about the ‘class of 2019’ can be found here.

Are you a fan of Fast Running? Then please support us. For as little as the price of a monthly magazine you can support Fast Running – and it only takes a minute. Thank you.

The post When dedication becomes destructive appeared first on Fast Running.

2018 – where to start? It was a year of massive highs in terms of my running career, but I failed to take proper care of myself or to acknowledge that cracks beneath the surface were appearing. I needed help and it resulted in me crashing into 2019 in a very bad place both mentally and physically.

Let me introduce myself. My name is Katherine Wood and I’m a 23 year-old endurance runner living in Manchester and training and racing with Sale Harriers.

I moved to Manchester after studying for my undergraduate degree in Biochemistry at Oxford University in the summer of 2017 to start a PhD in the field of Genetic Medicine.

For the last 10 years, my life has been deeply intertwined with mental health issues. At the age of 13, I was hospitalised as an in-patient with anorexia nervosa.

To give some context, I had been a competitive swimmer and runner as a child and a young teenager, but as I went through puberty I struggled to balance my energy output of training with energy input. When this was combined with my perfectionist tendencies, high-achieving nature and extreme determination, I rapidly transitioned from losing some weight accidentally, to suffering from a full-blown eating disorder which was picked up too late.

My periods stopped, my bone density had plummeted and at the time of hospitalisation I had a BMI of less than 14.

While I was never treated as an in-patient again, I had several relapses over the following years requiring out-patient care, the most notable of which being when I moved to Oxford to start studying for my undergraduate degree.

During the first term, I lost a huge amount of weight and without parental nagging, I clearly wasn’t able to cope or manage myself nearly as well as I’d thought. Just before the Christmas vacation, I was told to gain weight over the holiday or I would not be able to come back for the next term and would have to take a break in my studies.

This proved motivation enough to kick me into action and I successfully gained back the weight I had lost over the following few months, this time using my determination and general pig-headedness in a constructive manner to put my everything into recovery.

While depression and anxiety plagued me throughout my time at Oxford, my weight remained stable after this at a relatively healthy level, I was allowing myself more flexibility as to what I ate (it turned out that chocolate in moderation was a fabulous antidote to essay crises and finals’ stress!) and I was able to start running again.

My first half marathon and increased training

My first half marathon was 2015 before and completing my first marathon in October 2016, in a respectable time of 3:20. I felt in control of my eating disorder (rather than it controlling me) and I believed that I would never let myself slip back into my old ways; I had everything to gain by remaining healthy, and so much to lose if I didn’t.

I then joined Sale Harriers in October 2017, and over the next year, I really became immersed in the sport of running. My training volume increased – I was now including double sessions on some days and the purchase of an exercise bike meant I was incorporating more cross-training into my schedule – but I felt great for it.

In 2018, I lowered my marathon PB to 2:49 in Bavaria and I decided to enter the Yorkshire marathon in October, with the Scottish Half Marathon and Robin Hood Half Marathons in September as my training races in the lead-up.

The combination of increased mileage and cross-training seemed to have been successful so far so I continued to up my miles further; I was now running between 90 and 100 miles a week, with double runs every day, a 20-miler every Saturday. I was also doing at least an hour of cross-training and core strength work every day.

But beneath the surface, cracks were beginning to appear. I was aware that I had lost some weight, and that it was lower than it had been for a few years. I had tried (and failed) to come off my antidepressants over the summer, but it had thrown me out of balance and routine, and I was really struggling with my mood.

At the beginning of September, I contracted cellulitis in my lower left leg – the pain and swelling had initially led me to think this was a running injury, but a trip to the physio and then the GP confirmed it was instead an infection.

I was put on a course of antibiotics which helped to clear it, and while the pain was excruciating, I refused to stop training or miss a single run, although I had to forgo running the Scottish Half Marathon.

Winning the England Half Marathon title and a 2:41 marathon

With the clearance of the infection, I decided that I would still run the Robin Hood Half Marathon, which incorporated the England Athletics Half Marathon Championships, two weeks before the Yorkshire Marathon.

In racing terms, it was a huge success. I not only won, but I also ran 77:34 to record a two-and-a-half minute PB.

With the win at the forefront of my mind, the last fortnight of training before the Yorkshire Marathon was now underway. I was aware that my weight had dropped slightly more, but I kept telling myself that things would sort themselves out.

My performances were improving and I thought my body was coping well and responding to the amount of training I was doing; I would sort the weight out after the marathon.

Despite what my fellow runners were telling me, I decided not to bother with tapering for the marathon; I couldn’t bear the idea of lower mileage weeks and I went into the marathon on the back of an approximately 80-mile week.

As with the Robin Hood Half, things couldn’t have gone better. By mile 20, I knew I had several minutes on Julie Briscoe and although I was beginning to really feel the cold and wet, I pushed myself on to cross the finish line in a huge PB of 2:41:33. It was the biggest running victory of my life.

Soon afterwards though things would take a turn for the worse. I was on such a high that I didn’t give myself any sort of recovery or rest and I was back to a normal training week the day after the marathon.

Furthermore, Liz Yelling had also agreed to coach me remotely, something I was over the moon about.

My health was declining, but I couldn’t stop training

However, two weeks later, I found myself back at the GP being prescribed another course of antibiotics as the cellulitis had returned on the other leg. As recurrent cellulitis is quite uncommon in young, apparently healthy females, the doctor questioned why this might be happening and suggested it may be a consequence of my low weight.

After standing on the scales for her, which indicated I now had a BMI of just 16, she told me that she was referring me to the NHS eating disorders service and requested several blood tests. When these came back, they indicated that my immune system was not functioning particularly well and my creatine kinase (CK) levels were elevated, a mark that the muscles in my body were breaking down.

We were now into November, and yet again I resolved that I needed to sort myself out in order to keep training and performing to the best of my abilities. And yet, despite the racing calendar coming to an end for 2018, I continued to train – now I felt like a failure if I wasn’t running 100 miles a week, doing an hour each night on the exercise bike and at least 30 minutes of core exercises per day.

Repeated blood tests showed the CK remained high and my weight was continuing to go down. I knew my diet had become far more restrictive again and I was worrying far more both about what I ate and how my body looked than I had for many years.

When December came, my fiancée and I went on a holiday – that was booked months in advance – to New York, but the trip was dominated by running and worries about food and on my return to the UK, my weight had dropped considerably more, giving me a BMI of just 15.

Christmas 2018 has to have been one of the loneliest and most difficult periods of my life so far. Hugely worried about Christmas dinner and that I might not be able to do all my training sessions. Christmas Day was certainly no rest day – I pushed myself to run a half marathon distance in the morning just in case I ate more than I wanted to later, but halfway round I felt something twinge in my hamstring and the rest of the run was a painful hobble.

Despite this pain, I continued to run and run and run. My hamstring was now very bruised and my whole leg was swollen and painful. The pace I was able to run was getting slower and slower, and I just felt completely alone and lost.

Enough was enough

I remember so well the day I decided to make a change. It was December 29th, and I had just read an article on Fast Running about another young female suffering from RED-S, and how, with the renowned sports’ and eating disorder specialist nutritionist, and founder of the #TRAINBRAVE campaign, Renee McGregor, she had been going through a long and difficult, but ultimately successful, road to recovery.

By this point, I knew I had to do something. My situation felt desperate and I realised that I couldn’t do this alone. Liz Yelling had some idea my weight was a bit lower than ideal and was aware of my history, but I hadn’t told her what was going on, my parents clearly didn’t know what to do (while I hadn’t owned up to how much weight I had lost, they could very clearly see how bad things were) and while extremely supportive, my partner was also at a loss.

Ultimately, I had to make the decision to change and act upon it – nobody else could recover for me. So I made contact with Renee and arranged a Skype consultation, and in the meantime, I wrote myself a 3000-calorie meal plan to follow, with the intention of continuing to train while gaining weight.

The day of my consultation with Renee finally arrived. I was anxious about talking to her, but since starting my high-calorie meal plan my weight had increased slightly and I was hoping that she would be able to provide me guidance on how to improve the meal plan while still training.

I think deep down I knew what was actually going to be said, but I was adamant I was doing the right things in terms of making positive changes towards recovery.

Of course, one of the first thing that Renee said was “I want to work with you and help me, but I will only do this if you agree to stop running or doing any exercise immediately”. I was absolutely devastated – I had put on some weight while still running, so why couldn’t I carry on this way?

Renee explained to me that I was putting myself in great danger, that my heart could give way at any moment, my bone health was probably very poor and that I was very unwell. I was so caught up in the eating disorder that I couldn’t see those home truths, but deep down I knew I had no choice; I had approached Renee for help and if I didn’t do what she asked or work with her, I probably was either going to be hospitalised or die.

Renee suggested that she and Liz work together to support me, and reminded me that I was not alone in this and that I couldn’t do this without any help and expect to recover long-term.

The day of the consultation was one of the bleakest days of my life; I cried and cried, many things were thrown across the room in anger and all I wanted to do was to curl up in a ball and hide away from the world. But it was also one of the most important days of my life. I had made the very positive step of reaching out for help and had approached arguably the most qualified professional in the field. Things could only go up from here.

It’s been a whirlwind

Over a month has passed since that initial consultation, and things have been a bit of a whirlwind. The mental effort to stop myself from training has been hugely draining, and I have found it unbelievably difficult emotionally to cope with eating a huge amount and not exercising.

On the positive side of things, I have managed to gain several kilograms of weight, and as a result, I am now allowed a couple of short runs a week, a little bit of exercise biking, and I have started doing yoga and pilates.

I am hoping that by doing things like pilates (which are extremely good for runners anyway) that when I do get back to training and racing properly, I will go into things in much better shape and come back stronger than ever.

I have also been using the extra time I now have to try new things and be more balanced – I’ve been proactive in meeting friends for coffee, finding craft projects, baking, my partner and I got a pet snake, and I even managed to brave a pub quiz.

On the more negative side, all the evidence suggests my body is really struggling, far more than it did when I first got ill a decade ago, probably to be expected given how long I have been ill and not providing it with the nourishment it needs.

My blood tests are still showing elevated CK, my lymphocyte count is very low meaning my immune system is very compromised and as a result, there are signs that I have had an acute infection in the liver. Additionally, the DEXA scan I had has shown very poor bone density, putting me well inside the osteopenic category, likely an effect of very little oestrogen production.

The likely outcome of this is that I will be going on hormone replacement therapy (HRT) to provide an oestrogen ‘boost’ until my body starts producing enough naturally due to my long history of illness and menstruation problems.

Wider problems and lack of support

One thing that has really shocked me is the availability (or lack thereof) of services in the NHS. After waiting three months for my NHS Eating Disorders Unit initial assessment, I was told that this appointment was to decide which waiting list to put me on to receive the appropriate treatment.

When I asked about the waiting times, I was told that because I had been put onto the fast track system due to my low BMI when I was referred it should be less than 12 months, but if I had been on the general waiting list the waiting time could be up to two years.

For someone with an eating disorder, two years is far, far too long – at least 20% of anorexics die prematurely, with suicide and cardiac arrest being the two highest contributors to this figure.

The lack of funding and support for people with eating disorders and mental health problems in general is shocking; I am extremely fortunate I have a family who can support me financially to see a private specialist, and while the work Renee does through TRAINBRAVE is outstanding, there simply isn’t enough money to offer help to everyone in situations like mine.

While still in an early phase of recovery and it will be a long road ahead, I am determined to succeed and overcome my eating disorder this time. I want to be the athlete I know I am capable of being without nutrition or my weight being a limiting factor.

I would not wish any of this on my worst enemy – anorexia and sports-related disordered eating has ruined the last decade of my life, I have missed out on so many things in life because I have been ill for so long, and although I know it is wrong to feel guilty or blame myself, I feel a huge burden on the people around me who have supported me and whose lives have been turned upside down because of my illness.

All I can say is that if you have even the tiniest shred of worry that a fellow athlete is over-training or under-fuelling or becoming obsessive, do not ignore it or push it under the carpet until it is too late. This is my motivation for sharing my recovery. If opening up about my own experiences with disordered eating and sports helps one other person – who might be going down a similar pathway and hasn’t yet reached out for help – then sharing my story is the right thing to do

We need to break the taboo around the subject of RED-S, anorexia and sport if we are to tackle this issue head-on.

This week is Eating Disorders Awareness Week and one charity that is doing great work to build awareness, provide resources and offer support is Beat, the UK’s leading eating disorder charity. Further information and advice can be found here.

Are you a fan of Fast Running? Then please support us. For as little as the price of a monthly magazine you can support Fast Running – and it only takes a minute. Thank you.

The post Seeking help after ignoring the signs appeared first on Fast Running.

November is National Eye Donation Month in the US, a time to spread awareness of the gift of restored sight. Here in the UK there is also a shortage of donated corneas and so fewer people benefit from this life-changing treatment than there should be.

Erika Kelly hopes sharing her story will encourage more people to sign up as organ, eye, and tissue donors, so one day they could share the gift of life and restored sight.

Erika’s story

I’m not entirely sure of the exact age at which I was affected by sight loss. I do however remember being in primary school, around the age of 9 years old and struggling more and more to read the whiteboard in class. I got my first pair of glasses around this time and I don’t think I thought any more about it.

As a kid growing up, I was regularly in and out of hospital experiencing corneal abrasions. My siblings were the same and my mum used to joke that we were born with season tickets to A&E. It was when I experienced erosion of the eye and subsequent ulceration around the age of 14, that I was referred to St Paul’s Eye Unit at the Royal Liverpool University Hospital and placed under the care of Mr Batterbury (St Paul’s Consultant Ophthalmologist & Corneal Specialist).

It was discovered that there was history of ‘Lattice Corneal Dystrophy’ within the family, and that soon became my diagnosis, helping to explain the recurrent abrasions, poor vision, photophobia and discomfort.

There was never a sudden loss in sight – it’s been quite a gradual decline. It became more significant whilst studying A-levels in Sixth Form, but I never particularly attended to it as a real issue. I’d pull on my glasses and get on with the work, thinking everything was normal.

I sat my exams, applied to university and didn’t stop to comprehend the impairment occurring before me. Unfortunately, my vision worsened, and discussions for further treatment took place.

Undergoing corneal transplant surgery

In June 2011, I underwent corneal transplant surgery to the right eye and plans for University had to be placed on hold. In the meantime, whilst recovering, I applied to study some more A-levels specifically in Health and Social Care at University College, Isle of Man (UCM).

Months passed and it appeared that the transplant wasn’t having the desired effect. During my first year at UCM, I had to undergo refractive surgery with the aim of improving the visual outcome. With the addition of some new glasses and aids from Manx Blind Welfare/RNIB to assist with reading textbooks and whiteboards, I got through the two years, passing with high distinctions.

Having spent the last four years studying A-levels and feeling unsure of what path to take, I decided to take some more time out to gather work experience and earn. Following electrodiagnostic testing to rule out any issues in the signals between my brain and eyes, in August 2014, I had further refractive surgery. I then became the recipient of a second corneal transplant – this time to the left eye.

In terms of how sight loss has affected me… it has and it hasn’t.

I admittedly struggle on a daily basis, especially if I’m out and about in unfamiliar locations, forever bumping into things and mistaking a pile of leaves for a cat.

An example – I’m a competitive athlete and recently spent three months living and training at an endurance centre in Leeds. Within the first 10 days, I tripped and had to take a ride in an ambulance. I hadn’t seen some speed bumps and a slight dip in the road. In failing to use my hands to break my fall, I went flying down on to my forehead.

Photo: provided by Erika Kelly

The pool of blood on the floor spoke for itself. It wasn’t my finest moment, but thankfully nothing too serious! A good sense of humour prevails and I laugh it off, sometimes embarrassed but fully accepting of the situation. I also cannot for the life of me see well enough to notice and acknowledge people around me.

Close family and friends are aware of this, but others less familiar with my circumstances will probably think I’ve ignored them – I haven’t.

If someone waves, I’ll wave back. If someone says “Hi”, I’ll say it back. On 95% of occasions, I will have no idea of who I have just waved or spoken to, and seem to spend a lot of my time thinking I’ve seen “Barbara” or “Dave” and upon waving frantically at them, followed by getting closer, I realise the people in front of me are in fact complete strangers who are now staring at me, probably thinking I’m a complete weirdo.

With continually varying sight and symptoms that I can’t control for, I try to take each day as it comes. It’s only a barrier if others make it one. A visual impairment doesn’t define me, and it hasn’t slowed me down or stopped me pursuing anything.

I’m studying a BSc Psychology and Counselling degree, playing the harp professionally and competing internationally as an endurance athlete in the 20km race walk – having recently represented the Isle of Man in the Commonwealth Games on the Gold Coast, Australia!

It was an incredible experience, of which I will never forget and to finish in the top 10 was a complete bonus! I can’t wait for more experiences like that and will continue to strive to make the Great Britain team!

To end on a cliche statement (of which I firmly believe) – you can truly achieve anything you put your mind to, never give up.

I want people to know how great a difference they can make to two people’s lives if they tick the cornea box on the donor register – it is one of the most incredible acts anyone can do for another person.

You can learn more and become an organ donor here – and don’t forget to talk to your family and friends about your wishes.

Are you a fan of Fast Running? Then please support us. For as little as the price of a monthly magazine you can support Fast Running – and it only takes a minute. Thank you.

The post Erika Kelly’s personal challenge to overcome sight-loss appeared first on Fast Running.

Lauren Howarth recently stormed to victory at the Manchester half marathon, slicing nearly two minutes off her best to run 74:16. Howarth’s triumph was all the more impressive because she didn’t train specifically for the distance.

The 28 year-old locum doctor decided to race the half in support of her future sister in law, who has been diagnosed with bowel cancer. She admits her body is struggling to recover from her efforts in Manchester, but has no regrets.

“The half marathon was a bit of a last minute decision so I didn’t do any extra training,” Howarth tells Fast Running. “If anything I held back, as I was doing it for charity, so needed to make sure I made the start line because of previous injury problems.

“I loved it though, despite the Manchester rain! The atmosphere was great. I had no expectations, so just went out there and enjoyed it.  My dad planned his Sunday run so he could see me at four points on the course, and my mum joined him on the bike.

“Unfortunately I’ve picked up a few niggles post-race, but fingers crossed nothing too serious. That was to be expected though.”

Photo: Manchester Half

The former Team New Balance Manchester (TNBMCR) athlete says she’d love to step up to the marathon “one day”.

“It’ll be in a few year’s time though, hopefully after starting a family – no pressure Andrew!” she jokes.

The Andrew she is referring to is Hallamshire Harriers’ 13:47 ace Andrew Heyes, who she is set to marry in December. Heyes has been helping his future wife with her training, alongside her dad, John Howarth, since she left the TNBMCR set up in March. 

Running most definitely – and appropriately – runs in the family

Both her sisters run at a high standard. Older sister Becky is a 17:11 5k athlete and younger sister Abigail has run 16:45 for the same distance.

“I’m looking forward to training with Abi as she’s just moved back to the North West after completing her Foundation Dentistry year,” she adds, highlighting what a talented family the Howarths are!

“We’d love to go to the Mansfield cross country relays as a team of sisters! I’m sure Becky will plan a trip home from Florida where she works as an actuary one year to coincide!”

What a formidable thought!

Lauren Howarth with younger sister Abigail

It was Lauren’s dad who first took her down to the club when she was 10 years-old. He is still an actively competitive member of Leigh Harriers and Northern Masters, as is her grandad, Derek Howarth, now a V85.

Alongside being an obvious talent and source of support, her grandad also holds the British over-75 five mile road record. As if that wasn’t enough, there is a stand named after him at Leigh Harriers!

“My grandad has achieved so much in running in the masters events,” she says. “He’s an inspiration, and often reminds me he’s my number one fan!”

Howarth has also achieved impressive feats on the country, track and roads, including representing GB at the World and European Cross Country Championships on multiple occasions. 

This year has been a difficult one though for the girl from Greater Manchester.  

Battling injuries

In March she decided to leave TNBMCR following, in her words, “yet another serious injury”. 

Howarth has been plagued with stress fractures since 2009. She sustained the last one while running in the snow in February. Conceding her unhealthily low body weight caused her to develop osteopenia (the low bone density condition that preempts osteoporosis), she has a stark warning to other athletes.

“When I was underweight I was ignorant of the longer term effects,” she reveals.  “Unfortunately there wasn’t as much knowledge available then as there is now.

“Multiple people did try to help me, but I was blinded by my running success. It didn’t help that I would just bounce back from injuries.”

Howarth is clear in her mind that things need to change if other athletes are to avoid the issues she’s experienced.

Issues in running with under-fuelling

“There is a major issue in running,” she states. “You still see female – and male – athletes clearly under-fuelling but achieving success. It isn’t sustainable though, yet people become blinded by their performances.

“We still see athletes make sharp jumps in standard, race very well for a period of time, and then disappear for months due to injury. Some are selected for competitions and don’t even make the start line. I’m still suffering the physical and psychological effects of being stuck in that cycle when I was a younger athlete.

“I really think there could be a place for help and support when it comes to athletes who are clearly struggling, but are still being selected for GB teams. 

“Sadly, if an athlete is running well they will often not be thinking about the longer term consequences. It’s not always obvious though.

“I’ve heard a few people mention the idea of non-selection if an athlete is clearly struggling with RED-S (Relative Energy Deficiency in Sport). This would be very difficult to implement and would need a lot of input and a support structure.

“I know if I was pulled from an event as a junior athlete it would be very upsetting. However, it may have given me the prompt to make changes much earlier. It’s tough, but it could save careers.”

Howarth was a tiny 41.5kg at her lowest. Shockingly, she was put on the contraceptive pill to enforce periods that her body couldn’t produce naturally.

Team New Balance Manchester

Joining TNBMCR in 2015 while she was midway through her medical degree foundation years helped her achieve a healthier rhythm. However, the time was right to leave following that metatarsal fracture in February.

“I loved my two years there and learned a hell of a lot from Steve (Vernon, head coach and former international athlete), but the set up just wasn’t for me,” she explains. 

“I struggled with being a ‘professional athlete’ and was reluctant to quit my job. We have a mortgage, bills, a wedding, and everyday life things to pay for. I also wasn’t quite at the level to earn money. Andrew and I aren’t contracted, but got coaching, medical and physio support included. We also got altitude and warm weather trips, and kit of course.”

Howarth is grateful to still get New Balance kit drops – “every time is like Christmas” – and remains good friends with Steve and TNBMCR, while Andrew is still a member of the team.

Her health is a bigger priority now though than ever before

While she now has regular periods, is at a healthy weight and a recent DEXA scan revealed significantly improved bone density – it is now in the ‘normal’ range – she says her “bone architecture is likely lagging behind and will take years of remodelling”. 

“But I’m happy, healthy, and enjoying running,” she adds. “I eat more than I ever have done. Living with someone who is doing 100-mile weeks means there’s always a lot of food around the house!”

Happily, positives are beginning to emerge from the negatives experienced by athletes like Howarth regarding under-fuelling in elite sport.

FitrWoman and TrainBrave are just two examples of movements aiming to address those issues.

RELATED: Health is more important than fast times

Athletics and medicine – not an easy juggling act

Howarth would love to be involved in promoting the work carried out by movements such as FitrWoman. For now, she is understandably too busy working, preparing for her wedding and training.

“I currently work Monday to Friday 9-5, but I’m in the process of applying to reduce that to three days a week, to start in November,” she says. “This will give me more flexibility to train, spend time with family and concentrate on the wedding.

“After August 2020 I’d like to go into medical speciality training. This might be either GP or core medical training. That means night shifts and weekend work again.

“I lot of people say I’ve done very well to balance a medical career with running at a high level. 

“However, I’d say my health was severely neglected during medical school. Although I’ve achieved a lot, I have not managed it at all well. I’ve had more than eight stress injuries, poor bone density and anxiety.”

Managing stress and anxiety 

As if constant injuries and weight issues weren’t enough worry to contend with, her job adds another level of stress.

How does the Leigh Harrier deal with the pressures of life while trying to compete at a high level as best she can?

“Often I forget that what sets my job apart from many others is that fact that I’m dealing with people’s health and lives,” she reflects. “I can’t afford to make mistakes and get a lot of anxiety around my job. I worry a lot about the patients, especially over the weekend.

“I’m learning to deal with this better now – working more regularly helps with this, and I’m currently doing a bit of resilience training. Writing things down and reflecting helps too. I make a lot of to-do lists, have a structure to my day and like to keep busy. 

“Scheduling in naps or chill time can be part of the daily plan where possible. A glass of red wine in the evening helps to unwind too!

“We’re so lucky to live in the countryside and would love to make more use of the fantastic walking routes. However, after training and working it’s often nice just to sit in the garden and look out on to Kinder Scout.”

Marriage and family 

For now, her and Andrew’s forthcoming nuptials are taking up most of her spare time, along with helping support his sister Jenny. The mother of three daughters aged seven, four and one was diagnosed with stage 4 bowel cancer in June.

That Manchester half win helped boost the family’s Just Giving page, which is raising funds for Bowel Cancer UK.

The Heyes family has already raised thousands of pounds for Great Ormond Street following the death of Jenny’s son Elliot aged just 10 days in 2013. 

“Jenny is such an amazing person and role model, so the Manchester half provided the perfect opportunity to do something to support the family,” she concludes.

Understandably the irrepressibly positive running doctor can’t wait for their December wedding day, and the chance to relax as a family after a difficult year.

“Yes, we are both hoping for a crisp winter’s morning after the pre-Christmas cross country season,” she enthuses. “Although I do hope to race on the country soon, my body is taking a bit longer to recover from the half than I hoped, so if you don’t see me on a start line any time soon don’t be too surprised!”

Are you a fan of Fast Running? Then please support us. For as little as the price of a monthly magazine you can support Fast Running – and it only takes a minute. Thank you. 

The post Lauren Howarth is balancing medicine with athletics and a wedding appeared first on Fast Running.

The summer may well and truly have ended, weather warnings for wind are back in effect and it is only a matter of time before we move from summer pastures to our group’s aptly named ‘winter loop’.

At least I managed to get myself back to racing, with some feel of a summer road race, before the winter set in – even if it was an overcast Sunday morning on a windswept motor racing circuit.

My main goal in return to racing was simple, go out hard with the leaders, hang on and see what happens. All things considered, it went well as I took second place after sheltering the eventual winner from the wind for close to two miles.

A change of tactics is probably needed for the next race, but I made myself hurt again which was my purpose that day.

Photo: Pop Up Races

The mixed Raheny team took a valiant second place finish behind a team made up of the pre-race first and second favourite on the men’s and women’s side. Realistically we never stood a chance given the rules at play. I can just hope that road races moving away from classic club teams to anybody putting together a team for themselves doesn’t become a trend.

A break from running

The immediate post-race recovery was put on the back burner in the name of football. With the first race taken care of, I headed almost straight to the airport to fly to Poland and watch Ireland play a friendly in Wroclaw. Thankfully an international football break in early September every year gives me a chance to get away with my friends and see some different parts of Europe.

Three days of leading the exact opposite life of an athlete is not exactly sustainable, but being able to switch off entirely and take a break from thinking about running is necessary. I fooled myself into thinking I might get some runs done over there. My shoes never emerged from the bottom of my bag.

No long-term damage was done while away and normal service of training resumed when I got back. In other stages of my career I would’ve been very stressed out about taking three days off for a holiday, even days I wouldn’t be training hard anyway.

Accepting that in general, my training has been going well in the past months means I can allow myself a little respite and kindness when it’s appropriate.

As I’ve come through the past few years I’ve learnt that things won’t be perfect, things will come up, that means I have to be a little flexible. While previously slight changes in routine could play with my mental health, a big part of my journey has been learning to be less black and white in my thinking.

I’m progressing with my mental health

It is not always a winning battle but the general progression is going well. For the first time in some while, I can generally say I’m happy with where my mental health is at.

That isn’t to say I don’t have bad days, but for me, the largest victory is in smoothing out my mood graph and understanding when it is I feel down and being able to deal with it accordingly.

Opening up about this on Fast Running was a big step for me in actually admitting that these are things that I needed to address. In the past, I would hide any efforts to work on my mental health because that would be admitting to having a problem to begin with.

Now I have no fear of being fully open about going to see a counsellor, working with a sports psychologist, meditating daily (or as close to daily as I can). Journaling is the next tool I need to add to my routine. It is strange to think that I meticulously log my physical health on a daily basis but make no effort to keep a better tab on my mental health.

This blog gives me a great opportunity to write once a month about where I’m at but very often proves a more high-level exercise rather than examining the day to day feelings.

It is nice to have some time now to reflect on these things when the going is good. Having a race under my belt means I can fully move on from the spring and summer gone by. There is also time until I get fully back to the cross country so I can enjoy my training now and feel some of the old fitness returning.

Up next I have got the Rathfarnham 5k on Sunday (September 30), which is generally a good fast race and a chance to open the legs out. After that, I am very fortunate to be taking part in the Izumo Ekiden in Japan on October 8, so I should at least be guaranteed material for the October blog already.

It is great to feel a sense of optimism about where I am at and not just in a running sense. There is plenty to look forward in the coming weeks and months but for now, I can just happily live in the current day.

RELATED: Mental health: If I spark one conversation it was worth sharing

Kevin Dooney features in the ‘Fast 10: class of 2018’ and over the course of the year will share his running journey. You can read Kevin’s previous posts here and further information about the ‘class of 2018’ can be found here.

Are you a fan of Fast Running? Then please support us. For as little as the price of a monthly magazine you can support Fast Running – and it only takes a minute. Thank you.

The post Progress: back to racing and looking after myself appeared first on Fast Running.

In 2017, a heart scare forced runner Charlie Rogers to collapse in the final stretch at the Shropshire cross country championships. It resulted in the Loughborough student being hospitalised for 13 days, but a year later he still doesn’t know the cause of the problem.

“It was about 11 and a half km into the 12km race when it happened, which had been really tough,” he tells Fast Running. “I wanted to sprint to the finish so I started to push, but the next thing I remember is lying on the ground.

“There was a crowd over me, asking me if I was okay. I was just really, really confused. I vomited five or so times until there was nothing left and I fell backwards.”

Rogers’ heart had seemingly gone into overdrive and after being taken to hospital he was unable to answer simple questions.

“My blood pressure was super high and I could really feel my heart beat pulsating in my neck,” says the Shrewsbury AC runner. “At the hospital, they asked me my postcode and the scary thing was that I didn’t know.”

13 days and counting

It wasn’t just a quick in and out of the hospital for the runner. It took 13 days in bed before the staff were happy to realise him.

“I watched as though my body deteriorated and all the muscle mass that I had trained for during the winter months left me,” recalls the student. “I was trying to exercise every time I went to the bathroom, but the rest of the time I was just sitting in the bed and there was just no point.”

There wasn’t really a diagnosis though. Sent home with future tests still to be taken, an unfit and none the wiser Rogers felt at a loose end.

“Returning to a highly sporting university can mean it is difficult to avoid exercise, especially when you’re missing out on doing something that you love,” he says. “But every time I tried to go for a run my heart rate would spike and blood pumped hard through the veins in my neck.

“Even an angiogram deemed that my veins and arteries were fine. Not knowing made it more difficult, but I wanted to start running again.”

Still not knowing the cause of the health scare he made the decision to return to running and tried to cut out stimulants like coffee and focusing on sleep more.

“I still pertained to feel pain in my chest and neck following a hard rep session or hilly long run,” he explains. “However, I wasn’t going to let this ‘injury’, for which there was no cause, define how I lived my life. So I started to slowly increase the mileage and sessions throughout the first semester of my second year in university.

“Cutting out the stimulants, focusing on sleep and my health, I started improving. The condition or injury, whatever you want to call it, gets better when I’m fitter.”

Some would have considered walking away from the sport, but Rogers took the approach he felt was best and gradually built up his fitness, which eased the symptoms  – even if they never disappeared.

Still improving

After a summer of gradually building up his fitness, he progressively worked more on his speed during autumn and winter which resulted in some good cross country results and a 5k personal best. He was then off to Denmark of all places.

“In January I did a semester swap in Denmark and joined a Danish club, Aarhus 1900,” he says. “The warm welcome was just what I needed. In the long dark and cold training sessions and stretching long runs I really began to improve.

“Motivated on by a supporting club and following a training plan written by my previous school running coach, I targeted the 10km Danish National Championships on March 17th.”

Photo: Aarhus 1900

PBs all around

He enjoyed a solid period of training with his new club before the day came for the Danish 10km Championships in Middelfart. With a target of running under 35 minutes, Rogers did not disappoint with an excellent 34:39 showing.

“The time meant so much more to me than just a number, a race or a day,” he says. “For me, it represented a defiance against a limiting force and an expression of freedom.

“It showed how I wouldn’t let some irregularity define me, and how I would rather spend time doing something I loved over living a life of fear.”

In the months that followed the Aarhus 1900 athlete also recorded personal bests over 3km (9.21), 1500m (4.21), 800m (2.09) and a half marathon (83:00).

Looking to the future

Rogers is not out of the woods, but he is looking to the future with renewed optimism and taking a low tech approach in the style of the legendary Steve Jones.

“I sometimes still get pain in either my chest or neck following a fast rep session and have no diagnosis on my problem, but I’ve accepted this for now and have started to know when I’m reaching my physical limits in training or in a race,” he says.

“After a summer break, I’ve been training without a watch, going by feel, and really listening to my body. It’s a lot less stressful not to be chasing numbers for a change.”

He is now back in the high-performance environment at Loughborough, where there are plenty of people around to push you, but knowing when to hold back a little is key for the runner with an unknown ailment. 

“It still brings my standard up being at Loughborough, but I have to remember that some of the people around me are truly brilliant runners,” he says. “Getting carried away chasing others means you forget about how much you want to improve personally.”

So what is next for Rogers? 

“I’m targeting some more PBs this winter,” he says. “Telford 10k is fast, although I’ve heard it can bunch up at times. I want to run under 34 minutes there and hopefully also post a 5k PB around 16:10-20 just beforehand.”

It is refreshing to hear from someone who doesn’t let a problem define his life and is determined to take back control.

Many in a similar situation, rightly might be too scared to even start running again, let alone go chasing PBs. But ultimately only the individual really knows how their body feels, and hopefully, Rogers can be an inspiration to others.

“I don’t want to stop doing what I love,” he says. “Rather than be scared of what could happen, I have to accept it.”

If you would like to keep up with Charlie’s progress you can on follow him on Instagram and Facebook.

Cardiac Health

Please remember that Charlie started running again only after extensive medical checks. If you are experiencing similar symptoms then please see a doctor.

Every week in the UK at least 12 young people die of undiagnosed heart conditions. Cardiac Risk in the Young is a charity that supports anyone diagnosed and offer subsidised screenings for anyone 18 to 35.

Are you a fan of Fast Running? Then please support us and become a patreon. For as little as the price of a monthly magazine you can support Fast Running – and it only takes a minute. Thank you.

The post From a hospital bed to a season of running PBs appeared first on Fast Running.

The research led by Australian Catholic University’s Ida Heikura, and a multi-institution team of academics including Prof. Louise Burke from the Australian Institute of Sport and Dr. Trent Stellingwerff from the Canadian Sport Institute Pacific, aimed to “investigate energy availability, metabolic/reproductive function, bone mineral density, and injury/illness rates in national/world-class female and male distance athletes”.

The athletes in the study were separated into groups by reproductive function, testosterone levels and energy availability. This was calculated from seven-day training and food diaries.

With many athletes continuing to open up about their experiences of the female athlete triad and RED-S, the results from the research provide alarming evidence of the link between energy availability, reproductive function, bone density and injury/illness rates in male and female athletes.

In fact, the findings reported that bone injuries were four and half times more prevalent in the amenorrheic and low testosterone groups compared with others, as well as both male and female athletes with low energy availability.

Amenorrhea

Amenorrhea is defined as the “cessation in periods for six months in a woman (whether athlete or not) with previously regular menstruation”. This was highlighted by Anna Boniface in her interview with Dr Nicky Keay on Fast Running. In Heikura’s study, they defined three consecutive missed periods as a definition.

Within elite sport, there has been a normalisation of amenorrhea, and some coaches still misinterpret amenorrhea as a (wanted) sign the athlete is training hard enough.

When both athlete and coach refuse to address the issue, the problem is only exacerbated. An athlete may fear being kicked from a team or made to reduce the training they love if they reveal that their periods have stopped.

Some coaches even cultivate the sporting environment where amenorrhea is an inevitability. The heavy pushing of the idea that ‘light is fast’ above all else, including the importance of health and consistency in training, is part of the problem.

RELATED: Female athlete health: conversation is only the start

Stress fractures, illness and long-term health complications are the consequences and certainly shouldn’t be seen as normal.

Alongside this, the team looked at the robustness of diagnostic criteria from tools used to diagnose low energy availability in athletes, including tools that help identify possible contributors to the female athlete triad and RED-S.

Looking at the results from the research it highlighted that bone injuries were ∼4.5 fold more prevalent in amenorrheic and low testosterone groups. So if a female athlete has stopped having periods then she is four and a half times more likely to suffer bone injuries. That’s a huge number.

The study also discovered that current reproductive function tests (questionnaires/blood hormone concentrations) appear to provide a more objective and accurate marker of optimal energy for health than the more error-prone and time-consuming dietary and training estimation of Energy Availability (EA).

Simply if an athlete is experiencing menstrual dysfunction, it is a very good indicator that they do not have optimal energy for health, are more at risk of bone injuries and it should not be seen as simply part of being an elite athlete.

Male athletes are also susceptible to the risk of RED-s, bone injuries and long-term consequences. But there is not as clear an indicator as the menstrual dysfunction and one wonders if the sporting world appreciates the problem is there for both genders?

Yet Heikura states that there was a “relatively high prevalence of physiological symptoms of low energy availability in both elite female (37%) and elite male (40%) middle/distance athletes”. The ~4.5 fold prevalence in bone injuries was found in both male and female athletes with low energy availability.

If RED-s is a contributing factor to bone injury then treating just the bone injury could be ignoring the underlying major issue. When complete rest is needed but ignored, then in some athletes we only see a cycle of injury, recovery, injury, recovery. Without looking at the cause, an athlete may never solve the problem.

What can we do?

As a male coach and athlete, it still feels strange to write about this subject and I am far from knowledgeable on amenorrhea, RED-s and even how to discuss the topic with female athletes. Often I will wait for an athlete to bring up the subject rather than put it forward or just awkwardly do so, probably making things worse.

Yet we all just need to talk. Talk to female athletes, coaches, researchers, doctors, anyone who might know more than yourself. I even had a great conversation with my mum about the menopause and how it might affect someone’s life, running and training. I figured if I can chat to her about it then it might be easier elsewhere.

Athlete, coach and parent education is something that Boniface herself has advocated and Heikura also realises that “educating not just the athletes, but also coaches, other team members (physios, physicians, etc) and parents, is crucial”.

The researcher added: “The athletes tend to listen to their coach more so than, say, a dietitian. Coaches can also make a massive difference in the way they talk to their athletes about nutrition, body weight/composition management, etc.”

Ideas such as athlete mentoring for those going through puberty and improved access to medical support are other key developments suggested by Boniface on in a recent post on Twitter.

In the same way that a coach should never ignore the physical impact of an athlete’s job or mental stress of family relationships, a coach shouldn’t be ignoring a major factor in female energy levels every month.

Research in the field is still young, but academics like Heikura and the rest of the team behind this study are doing excellent work. She said: “While our findings are certainly interesting and unique in this athlete population (largest cohort to date with truly high calibre athletes), similar outcomes have been reported previously with smaller sample sizes, younger athletes, and sub-elite cohorts.”

Information from apps like FitrWoman can help athletes, coaches and parents too. The app lets users track their menstrual cycle and provides personalised training and nutritional suggestions tailored to the changing hormone levels. Co-founder of the app, Georgie Bruinvels, a research Scientist at Orreco, who recently completed her PhD at UCL, is passionate about the app and said: “I really want to empower women by helping them train smarter.”

From my discussion with Bruinvels, it soon became clear that knowledge and education about the menstrual cycle can also be seen as an opportunity to really optimise your training.

“It’s not just training stress that can cause the hormonal imbalance that leads to amenorrhea, but all types of stress,” said the academic, who has run a 2:37 marathon. “Understanding the best way to train alongside your menstrual cycle is one way to reduce this and FitrWoman can help you track your period and train smarter.”

With indications from research like this that show a strong correlation between amenorrhea and the likelihood of bone injuries, as well as menstrual dysfunction being an objective and accurate measure for athlete health we cannot afford to ignore the subject.

It doesn’t need to be rocket science or something we only talk to females about. Heikura said: “When it comes to athlete education, I believe explaining (in simple terms) the importance of adequate energy availability would be more useful than just telling the athlete to eat enough.”

Having open discussion and education is the biggest step we need to take. Heikura felt very strongly that if an athlete understands the signs and consequences of low energy availability and “how this chain of events eventually has an influence on bone injury risk and training ability, they may be more motivated to pay attention to adequate energy availability”.

The post Health is more important than fast times appeared first on Fast Running.

Dr Nicky Keay is no stranger to Relative Energy Deficiency in Sport (RED-S). The sports endocrinologist has extensive clinical expertise in RED-S and worked as a research fellow investigating anti-doping of the human growth hormone.

A regular contributor to the British Journal of Sports Medicine, Dr Keay has talked about her own experience with RED-S. A background in ballet, she didn’t start her periods until 32 years old. This was following the birth of her two children where she finally learnt how to relax.

From both her clinical, research and personal experience, Dr Keay enlightened to me the importance of hormones for both female and male athletes.

What is the difference between the Female Athlete Triad and RED-S?

The female athlete triad is part of the RED-S continuum. RED-S highlights that there is a broader spectrum of symptoms, affecting multiple systems.

These directly impact performance. Further research is ongoing to elucidate the details in some areas, as RED-S is a relatively new concept.

However, the crucial importance of RED-S, beyond the established female athlete triad, is that by highlighting these other elements, it helps detect those without stress fractures and includes male athletes. Using the triad alone, these athletes can slip under the radar.

Potential performance effects of RED-S

Not having periods. Sounds like an advantage? Why are periods important and how can they help performance?

What makes you run faster? Training hard. We train to gain physiological adaptations. Better VO2 max, shifting the lactate curve to the right. Stronger, more efficient muscles. But what drives these adaptations? Hormones.

Abuse and manipulation of hormones are a frequent method of doping. Performance is enhanced and dependent on hormone levels. They are stimulated during sleep and recovery, which are essential for the adaptation process.

Hormones are anabolic. They are responsible for bone health, protein synthesis, tissue repair and muscle growth.

Key players include:
– Human growth hormone (IGF1)
– Oestrogen
– Testosterone

This does not advocate using performance-enhancing drugs but highlights why it is important to have healthy hormone levels.

Periods are a barometer of hormonal health

This is dependent on the balance of training, nutrition and rest.

Men have no obvious indicator of their hormonal health. This makes problems difficult to detect, although regular morning erections is usually a sign.

Careful monitoring of frequency of colds, fatigue and “not feeling right” despite rest is often a sign of hormonal upset in both men and women.

The hypothalamic–pituitary–adrenal axis (HPA axis)

The hypothalamus is your neuroendocrine gatekeeper. Integrating internal and external inputs.

It interacts with the pituitary influencing our hormones, which is essential in the body’s homeostasis regulation.

The HPA axis works on a feedback loop. Chronic stress through overtraining, under fuelling, poor sleep and excessive anxiety can desensitise the HPA axis. The stress hormones cortisol and noradrenaline cause the body to interpret a constant “flight or fight” response.

The body’s perception of safety is threatened and amenorrhea occurs.

The oral conceptive pill. Is this the answer to amenorrhoea?

The oral conceptive pill gives you a withdrawal bleed.

This is NOT a period.

Athletes are often given a false sense of security taking the pill. Essentially it is reinforcing a medical menopause and masking amenorrhoea.

Does this pill protect bones?

Oestrogen is not the only influencer on bone health. IGF1, Ferritin and Testosterone are also involved.

Research is now indicating that the pill can increase binding protein globulins which reduces IGF1 and testosterone levels, therefore impacts bone health.

It advised not to be given the oral conceptive pill for the treatment of amenorrhoea.

Amenorrhoea – what actions should an athlete take?

Primary amenorrhoea is not starting your period by 16. Secondary amenorrhea is cessation in periods for six months in a woman (whether athlete or not!) with previously regular menstruation.

Either one of these is not normal.

It firstly requires further investigation for a diagnosis of exclusion. Could there be a medical cause for the amenorrhoea?

RELATED: Anna Boniface: the “P” word

Sinister pathology must be ruled out before confidently saying its functional hypothalamic amenorrhoea. A medic should only give the RED-S diagnosis once all else has been excluded.

When seeing a GP, be insistent on further investigation or specialist opinion. Not having periods should never be brushed off as just exercising too much.

Getting periods back

Fuel in the tank – never run empty: Energy deficits for the smallest amount of time will cause problems. Restrictions within diets can play havoc with hormones even if meeting caloric demands.

– Fuel immediately on wakening and regularly through the day.
– Nail the 30-minute window for post-training replacement.
– Top up during training.
– To run fast, don’t fast. Always eat before training.
– Carbs, protein, dairy, fats – keep them good quality and don’t exclude them.

Temporary taper: During recovery of RED-S scaling back the training will help bring the body back into balance. Some even remove themselves from training completely.

– Regular rest days.
– Plan training around life commitments.
– Monitor metrics such as heart rate and fatigue scores.
– Ensure any training limitations are clearly set and are reviewed regularly.
– Avoid double days.

Destress: RELAX. This will be specific for individuals. Learning how to switch off is paramount for happy hormones and reducing cortisol levels.

Medication
– Not the oral conceptive pill!
– Hormone replacement therapy may be required.

Keeping periods whilst keeping training load

As it’s been highlighted, calories in must be equal to calories out. If this achieved, training load should not impact menstruation.

A great example is triathlete Gwen Jorgensen posting her training metrics. She demonstrates that you can be a world-class athlete AND have periods (and a child!).

– Prioritise sleep and recovery. That’s where your hormones have the greatest impact. Don’t let your training go to waste by neglecting it.
– The pill is a FAKE period. It is not bone protective and could even be destructive.
– Never run on empty. Don’t restrict, don’t fast, eat regularly and eat balanced.
– Relax – protecting the body from the flight or fight response and feel in a safe place.

Track and record menstruation like any other training metric. It’s the barometer to your hormones!

Dr Keay is chairing the British Association of Sports and Exercise Medicine Spring Conference with world-renowned speakers in the field of sports endocrinology. Athletes, coaches and health care professionals are all welcome. Further information can be found here.

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Conversations about female reproductive health in sport have definitely started – that’s for sure. Athletes, coaches and governing bodies are getting involved in raising awareness of the risks of under eating, eating disorders and prolonged amenorrhoea.

What has become apparent is that it’s not just the occasional athlete who suffers the short and long-term effects of prolonged amenorrhoea on bone health; numerous athletic careers are being hijacked by repeated stress fractures.

But we need more than just conversations and awareness. The message is definitely getting out, but it’s not necessarily getting through.

Earlier this year, body shaming was again a feature of BBC athletics commentary; inappropriate race kit continues to make more than the occasional appearance; and, if social media is anything to go by, additional ‘punishment’ miles were yet again on the menu following Christmas indulgences.

If we are to truly get on top of the issues at hand, and break the cycle of energy deficit, amenorrhoea and bone injury, we absolutely need a cultural change. The solutions are both complex and difficult to implement. There is certainly no quick fix.

What follows are some ideas on where change can be implemented to improve prevention, diagnosis and treatment.

Remove barriers in the diagnosis and treatment of eating disorders

Imagine having severe insulin and blood sugar issues, but being told that you will only be diagnosed with diabetes once your foot needs to be amputated.

Imagine having coronary heart disease, but being told that you can only be treated once you’ve had your first heart attack.

Imagine suffering debilitating depression and anxiety and being told you don’t have an issue unless you’ve made at least one serious attempt on your life.

Now imagine having such a dysfunctional relationship with food, your body and your emotions, that you have essentially stopped eating. That you no longer feel hungry. That you have become obsessed with calories and ensuring that energy output is always higher than energy intake.

That even a single slice of bread means a punishing extra hour on the cross trainer. That you’ve got so used to lying about how much you’re eating (or not eating) that you don’t even notice you’re lying anymore.

That you’ve become skeletally thin, but keep thinking that you need to lose more weight. And then imagine being told that your BMI needs to fall even further for you to receive the medical attention you need.

Eating disorders are complex mental illnesses – albeit ones which are compounded by the physiological and biochemical effects of starvation – requiring psychological treatment, and not simply solved by a visit to the nutritionist.

With denial a major feature of anorexia in particular, each and every individual who seeks help for their eating disorder, must be treated with urgency, irrespective of whether or not their current weight places them in the ‘severe’ category, or whether or not their weight loss has been drastic enough to tick all boxes for diagnosis.

Diagnosis of anorexia, in the past, depended on weight loss leading to body weight at least 15% below that expected. That has changed in recent years, and there is no set weight listed in the most recent DSM criteria for anorexia, though BMI is still often used to classify severity.

Extreme weight loss should be considered a consequence rather than a cause or characteristic feature of the illness. A mental illness shouldn’t depend on a physical outcome for treatment to begin, particularly when early intervention greatly improves the prognosis. An individual should never be told that they need to be thinner or weigh less in order to receive treatment.

Not all athletes at risk of menstrual dysfunction or bone loss have an eating disorder. And those with an eating disorder are not the only ones that require help. But until eating disorders are treated with some level of urgency – and until we stop justifying disordered eating as a normal feature of endurance running – we have very little hope of treatment in other cases.

Downgrade the role of cross training

Your life is an imbalance… you’re not eating enough… your endocrine system is under so much pressure that your periods have stopped… your bones are breaking down… your body has had enough… you’ve just been diagnosed with yet another stress fracture.

Why then is your first thought to start twice-a-day, soul-destroying, time-consuming cross training in an attempt to maintain fitness, and then to adjust your eating patterns to ensure you don’t put on a single ounce of ‘unwanted’ weight during your injury ‘layoff’.

Listening to your body? If you can’t hear its desperate screams for help, how are you ever going to learn to answer its subtle warning whispers?

Anna Boniface is one athlete who has shared her story about amenorrhoea, overtraining, under fuelling and the resulting stress fracture. Now she is progressing with her comeback and recently wrote specifically about cross-training saying: “retrospectively, I should have taken this initial period not training completely. My body was screaming for some R & R. Continuing to plough away, I was still in that energy deficit, stalling my recovery.”

This is not to say that cross training doesn’t have its place.

In fact, it could play a much bigger role than it does in adding variety and reducing impact in the regular training programme. It is vital in the return to training after injury, and, in some cases, it can allow individuals to overcome a badly timed injury and keep dreams on target.

It can allow athletes to keep their head ‘in the game’ during times of injury, and some level of maintenance is good. But, as Katie Kirk, among other athletes, has recently discovered, it’s not the be all and end all!

In fact, you may later come to resent all that extra time you’re spending in the pool and on the cross trainer. And this can leave you more likely to throw in the towel altogether the next time you get injured.

Perhaps it’s not just your bones that need a rest – your mind may benefit from some downtime too. Use your injury time to do the things that you never have time to do. And if you get some space away from running and gain a little bit of weight along the way, then maybe that’s a good thing. Listen to your body!

Ensure that there is a structured referral process

Even if you’re really clued up on the causes and consequences of undereating and menstrual dysfunction. Even if you can spot and raise issues, and even if you have an open relationship with your athletes.

You can still feel desperately hopeless when faced with an athlete who reports that they have not yet started their periods or are having real issues with food and body image.

That is not your fault. I did a PhD on the subject, know pretty much all I ever want to know about the endocrinology of the female reproductive cycle and the biochemistry of the bone remodelling process. And even I’m still not sure what the next steps are when faced with an athlete suffering from some or all the elements of the Female Athlete Triad/RED-S. We are all hopelessly unsure what to do. That, above all else, needs to change.

The issues leading to our communal sense of hopelessness are multifactorial. The logical next step with primary amenorrhoea, for example, is to send the athlete in question to see their GP where underlying issues can be ruled out.

But in many cases, the doctor will then say that there is nothing physically wrong; that the lack of periods is due to their training load, and that amenorrhoea is ‘normal’ for athletes.

Common, it may well be, but healthy it definitely is not. Worst case scenario, the athlete is sent away and told not to worry about it.

The best case scenario is they are prescribed the pill – a bit like sticking a small plaster on a 6-inch laceration – told to consider calcium supplements, and possibly sent for a DEXA scan.

In this situation, and especially if it’s a whole body scan, the results may be normal, not just because the issue hasn’t got that far yet, but because whole body scans can mask underlying issues in trabecular bone (the spongy bone where the real problems lie).

Addressing the cause

Treatment needs to start addressing the causes, not just deal with the consequences. Whether or not low body mass is considered an inevitable feature of the endurance athletes, the energy imbalance should be addressed. Menstrual function should be restored. And every effort should be made to increase bone mineral density to normal age-matched levels. But all this takes time. Time which an athlete doesn’t ever believe they have. But the alternative is far bleaker.

When an athlete seeks medical help, they shouldn’t accept a quick, sticky-plaster, solution. They shouldn’t be told that what they are going through is a normal consequence of sports participation.

They may well have to fight for the support they need. And in many cases, the medical support required may lie outside of the public health service. Their fight would be immeasurably easier if a list of suitable practitioners was available, and not just of NGB sports medics which a select number of high-performance athletes have access too. But also other practitioners – dietitians, nutritionists, psychologists and counsellors – who will help in their return to help.

Education and research have improved greatly in recent years, and a lot more is known about treatment than a decade or two ago. It’s time now to put the final jigsaw pieces in place.

RELATED: Broken dreams: why we need to break the cycle

Make Long Term Athlete Development something more than a romantic ideal

We talk about Long Term Athlete Development. We know what it is, we understand the importance of it, and we like the idea of it in theory.

In practice, however, we continue to push athletes too young, entertain their ideas of trying to qualify for every international championship going, and cut the end of season break short to get ready for the next major championship, which is only ever a few weeks away.

We’ve become obsessed with endurance, without any consideration for age appropriateness, and uncovering the next child star. We behave like the next big competition is the only one left in the life of young athletes, and we are so desperate for success that we attach the same glory to underage medals as we do to senior success.

Then we place clearly unhealthy young athletes on the front covers of our athletics magazines, where the image a lot of their aspiring peers see, is that in order to win, you need to be thin too.

That’s not to say that we shouldn’t encourage competition at a junior level, that we don’t get excited about junior records, nor that we discourage aspiration. But underage success should never come at the expense of developing the skills and capacity for success later in life, or, more importantly, at the expense of future health.

Junior competition should ultimately be a stepping stone along the way, not a destination in itself. It should be about getting an athlete to the best possible position to train at a senior level, without draining them of their physical and psychological reserves. Athletes should be gliding into senior competition, ready to up the ante, not reaching 20 already drained of their physical and psychological reserves.

There’s no doubt but that Olympic champions are constantly pushing the limits of human health and performance. But in most cases, they are fully grown adults who have a sound training base, built over a long period of time.

Their health matters too, of course, but there’s a big difference in pushing the limits for a few years in your twenties and depriving a teenager of reaching peak maturation.

In many ways applying long-term athlete development requires guts.

It definitely won’t make you popular in the short term. But taking a long-term approach will, absolutely, help prevent many of the health issues faced by young endurance athletes. It’s time to start putting ideology into practice.

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