From RED-S to Resilience: An Ultra Runner's Journey Through Overtraining, Hormonal Havoc, and Healing

RED-S (Relative Energy Deficiency in Sport) isn't just a condition affecting elite athletes – it's a serious health concern that can impact any active woman who's under-fueling while over-training. In this powerful episode of The Flow State Podcast, hosts Monica Grohne (founder of Marea) and registered dietitian Norah Candido sit down with professional ultra runner Jazmine Lowther to explore her harrowing journey through RED-S and the critical lessons learned about female athlete health, recovery, and resilience.

What Is RED-S and Who's at Risk?

RED-S (Relative Energy Deficiency in Sport) occurs when there's a mismatch between energy intake and energy expenditure, leading to impaired physiological function. While previously known as Female Athlete Triad, the condition affects both men and women across various sports including:

• Endurance sports (ultra running, marathon training, cycling)
• Aesthetic sports (gymnastics, dance)
• Weight classification sports (boxing, wrestling)
• Rock climbing and other sports emphasizing leanness

The concerning reality? You don't need to be a professional athlete to develop RED-S. Any woman who's under-eating while over-exercising – whether training for a marathon or following restrictive diets combined with excessive cardio – is at risk.

Jazmine's Path to Professional Ultra Running

Jazmine's athletic journey began in childhood with natural endurance ability, later evolving through rock climbing before finding her calling in ultra running during COVID-19. Her breakout performance came at the Canyons Endurance 100K in 2022, where she won and set a course record as a complete unknown, launching her professional career with sponsorships and international racing opportunities.

However, the transition from passionate amateur to professional athlete came with hidden dangers that would soon surface in devastating ways.

The Warning Signs: When the Body Starts Breaking Down

Despite her success, Jazmine was training 20-30 hours per week while unknowingly under-fueling her body. The warning signs of RED-S emerged gradually:

Early Physical Symptoms:

• Night sweats and hot flashes
• Severe sleep disturbances requiring prescription medication
• Menstrual cycle changes – lengthening cycles and decreased flow
• Unexplained weight gain (20-25 pounds despite high training volume)
• Intense sugar cravings and digestive issues

The Breaking Point:

After a race in Spain where Jazmine placed second despite feeling terrible, her body completely rebelled. Within weeks, she developed multiple stress fractures – seven stress reactions and two complete fractures across all five toes. Her digestive system failed, she became afraid to eat most foods, and her menstrual cycle disappeared entirely for months at a time.

The Dangerous Cycle of Under-Fueling

One of the most counterintuitive aspects of RED-S is the weight gain that often occurs despite severe under-eating. As Jazmine explains, when the body perceives starvation, it:

• Slows metabolism to conserve energy
• Shuts down reproductive function as non-essential for survival
• Stores any incoming calories as fat in preparation for continued starvation
• Increases cortisol production, leading to inflammation and poor recovery

This biological response creates a vicious cycle where athletes often respond to weight gain by further restricting food intake, worsening the condition.

The Long Road to Recovery: What Actually Works

Jazmine's recovery took nearly two years and required fundamental changes to her approach:

Immediate Actions:

• Reduced training volume by 50% – down to 10 hours per week, zone 2 only
• Eliminated fasting and restrictive eating patterns
• Started eating breakfast within 30 minutes of waking
• Added substantial carbohydrates back to every meal

Nutritional Recovery:

• Whole food approach with adequate calories and macronutrients
• Pre, during, and post-workout fueling with 80-90 grams carbohydrates per hour during training
• No fasted training sessions
• Adequate protein and carbohydrate within 30 minutes post-workout

The Role of Support:

Working with coaches who understood female physiology and were willing to address hormonal health proved crucial. Many athletes struggle with coaches who dismiss or don't understand menstrual cycle tracking and its importance for training optimization.

Current Approach: Preventing Relapse

Now competing again, Jazmine maintains vigilant awareness of RED-S warning signs:

Cycle Monitoring:

She tracks her menstrual cycle data meticulously, noting that after a recent 100K race, her cycle lengthened to 55 days – a clear indicator that she'd pushed too hard and needed to adjust training and nutrition.

Training Philosophy:

• 3-5 strength training sessions weekly with heavy weights for bone health
• Lower overall mileage with strategic intensity
• Recovery-focused approach rather than constant fatigue
• Individualized nutrition based on training demands

Red Flags Every Active Woman Should Know

Physical Warning Signs:

• Irregular or absent periods
• Frequent injuries, especially stress fractures
• Unexplained weight changes
• Persistent fatigue despite adequate sleep
• Digestive issues and food fears
• Sleep disturbances

Behavioral Red Flags:

• Fasted training sessions
• Restriction of entire food groups
• Obsessive calorie counting or food tracking
• Training through pain or illness
• Comparing training volume to others on social media

The Mental Health Component

The psychological impact of RED-S extends far beyond physical symptoms. Jazmine experienced:

• Loss of identity when unable to train normally
• Body image struggles with weight fluctuations
• Imposter syndrome when competing at different body weights
• Social isolation from the athletic community during recovery

Recovery required not just physical healing but also mental health support and rebuilding a healthy relationship with food, exercise, and body image.

Prevention and Early Intervention

The key to preventing RED-S lies in education and early recognition:

For Athletes:

• Track menstrual cycles consistently and review data regularly
• Fuel adequately for training demands, including pre/during/post nutrition
• Work with knowledgeable coaches who understand female physiology
• Prioritize sleep and stress management
• Strength train regularly for bone health

For Coaches and Support Teams:

• Create safe spaces for discussing hormonal health
• Understand female physiology and cycle-based training
• Recognize warning signs early and address them immediately
• Emphasize health over performance metrics

Key Takeaways for All Active Women

1. RED-S is preventable but requires proactive awareness and intervention
2. Menstrual cycle tracking serves as a vital health indicator, not just for fertility
3. Under-fueling affects every body system, not just reproductive health
4. Recovery takes time – expect 6 months to 2 years for full healing
5. Professional support matters – seek practitioners who understand sports nutrition and female physiology
6. Individual approach is essential – what works for one athlete may not work for another

The Broader Implications

Jazmine's story highlights critical gaps in sports medicine education and the need for better support systems for female athletes. Her experience demonstrates that even elite performers can fall victim to RED-S when proper education and support systems aren't in place.

The conversation also underscores the importance of individualized approaches to training and nutrition, rather than copying what works for others or following social media influencers who may unknowingly promote unhealthy practices.

Resources and Support

For anyone recognizing signs of RED-S in themselves or others, seeking professional help is crucial. This may include:

• Sports medicine doctors familiar with RED-S
• Registered dietitians specializing in sports nutrition
• Mental health professionals experienced with eating disorders and body image
• Qualified coaches who prioritize health over performance

Remember: You don't have to be a professional athlete to deserve professional support. Every active woman deserves access to proper education about fueling her body and recognizing warning signs of energy deficiency.

Jazmine's journey from RED-S to resilience serves as both a cautionary tale and a beacon of hope – showing that with proper support, education, and patience, full recovery is possible.