Low Energy Availability (LEA) and Relative Energy Deficiency in Sport (RED-S) w/ Katie Schofield, Ph.D.

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Are you struggling with low energy availability? Do you know the signs and symptoms to look out for (even the less common ones)? What about how to navigate and help yourself so that you can continue sports if diagnosed?

In today’s episode. I am speaking with fellow New Zealander, Katie Schofield, Ph.D., who is a former international track cyclist, registered nutritionist, and holds a Ph.D. with a specialty in LEA and RED-S which is exactly what we are diving into today.

We are getting to understand what Low Energy Availability (LEA) & Relative Energy Deficiency (RED-S) truly are, what symptoms can you expect to experience & how they can affect your daily life, how proper nutrition plays a role, and why having a coach that understands LEA & RED-S can make a world of difference in your growth and performance. Plus, if diagnosed with LEA or RED-S, then what should your next steps be?

While this may feel new, LEA & RED-S are actually very common and the continued research is edging toward many people being at risk for these. Katie is an amazing person to learn about this from since she did her doctoral research on it and was diagnosed with RED-S back in 2014. So she has massive amounts of experience and knowledge from both the educational and personal experience sides making her a great resource of information. 

Whether you are curious about LEA & RED-S, think you may be experiencing the effects, or have already been diagnosed, this episode will answer your questions and more. Enjoy!

Did you learn something new about LEA & RED-S in this podcast? Did you have an AHA moment while listening? Let me know over on IG!

About Katie Schofield:

Katie was a former member of the NZ elite track cycling team between 2012-2016 and competed in multiple World Cup and World Championship events. Prior to her cycling career, she completed degrees in exercise science, nutrition, and a Master of Physical Education at the University of Otago, NZ. Katie retired from competitive cycling in mid-2016 to undertake a Ph.D. at the University of Waikato, which was inspired by being diagnosed with Relative Energy Deficiency in Sport (RED-S) in 2014. Katie’s doctoral research investigates the impact of energy deficiency on the body and the socio-cultural contributions to energy deficiency in elite athletes. Her future goals are to educate and inform exercising populations, using her research knowledge and personal experiences, to enhance their understanding of sport-science, health, nutrition, and athletic performance.

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Transcript for Low Energy Availability (LEA) and Relative Energy Deficiency in Sport (RED-S) w/ Katie Schofield, Ph.D.

Siobhan Milner:

Hi everyone. I’m Siobhan Milner, and this is Total Performance, a podcast dedicated to all things athletic performance and injury prevention. Join me and my guests as we explore the many aspects that come together to build our total performance picture. Let’s get into it.

I am super excited to welcome my guest, Katie Schofield.

Katie was a former member of the New Zealand elite track cycling team between 2012 to 2016, and she competed in multiple World Cup and World Championship events prior to her cycling career. She completed degrees in exercise, science, nutrition, and a master of physical education at the University of Otago in New Zealand.

Katie retired from competitive cycling in mid-2016 to undertake a Ph.D. at the University of Waikato, which was inspired by being diagnosed with relative energy deficiency in Sports Reds in 2014. Katie’s doctoral research investigates the impact of energy deficiency on the body and the sociocultural contributions to energy deficiency in elite athletes.

Her future goals are to educate and inform exercising populations, using her research knowledge and personal experiences to enhance their understanding of sports science, health, nutrition, and athletic performance. Welcome, Katie.

Katie Schofield

Hi Siobhan. Thanks so much for that lovely introduction, how are you doing?

Siobhan Milner

Yeah, really well. Thank you. Yeah, thank you for getting Up early for us. It’s 6:30 AM over where Katie is on the total opposite side of the world.

Katie Schofield

Yeah. I just love how this connection has come about, you know, like we were talking before and two Kiwis talking, but on the other side of the world.

Siobhan Milner

Yeah. That’s really nice. Just before we were on air, we were talking about how I didn’t actually realize Katie was a New Zealander until I reached out to her, so it’s kind of crazy. We’ve got the same academic background in terms of institution as well. So there’s a lot happening there.

Katie, I wanted to ask you because when I was a young endurance athlete, I experienced something that was at the time called ‘female athlete triad’. So can you tell us a little bit about what RED-S is because this is obviously a big focus for you in your doctoral work. And I also wanna know, is this just a new name for the same syndrome or have we learned some new things in the last 15 or so years?

Katie Schofield

Yeah, sure. I think it’s important that maybe we go back into history and we just start with the triad. So the female athlete triad is where we have this triangle, where we have three key areas, which is the low energy availability, and that’s where you’re just not consuming. The calories to sustain normal daily living.

And then that can have an effect on our menstrual cycle. So that’s the other component of the triad, which is menstrual function. And then the third component of the triad is bone health. And so there was this kind of, this correlation between having low energy availability and then that would have an impact on your menstrual function and then that can have an impact on your bone health.

But through time they realized that there wasn’t this kind of step-down correlation. There was this relationship between all. So they were synergistic in some capacity and they can all impact each other. But then it was like you can have one or more of those symptoms to then be classified as having the female athlete tried and it’s also important to note that you could have any one of those components at a different severity level. So it’s, it’s kind of like on a continuum line, and that’s where the triad is now. It’s like this pyramid, you know, we, you know, there’s some images that you can find just if you Google female athlete triad.

There’s this, this pyramid that goes on, on a scale now in terms of, REDS or RED-S, however, you pronounce it, is fine, Relative energy deficiency in sport. So that was developed in 2014 by the International Olympic Committee, and it doesn’t replace the triad, I guess it was developed because it accounts for a much broader range of symptoms that can be affected by low energy availability.

Both paradigms do agree that issues are caused by low energy availability or energy deficiency. So what the RED-S paradigm or model incorporates the triad within its model. So you’ll see radial diagrams if you Google RED-S, and you could see there’s a little triangle within that model, but it also expands to account for many other body systems that are affected by LEA. I liken radius as an umbrella term. So you have many impairments to the variety of body systems. So we are talking about the menstrual function, the bone health, so that’s the triad. And then there’s other systems like the immune system, gastrointestinal system are the endocrine metabolic systems, cardiovascular, and there’s also a psychological component in there, which I really like, but also RED-S. Then there’s another radial diagram that looks at the performance effects as well, which the triad doesn’t really account for. So that includes performance effects such as, decreases in strength, decreases in aerobic endurance, inability to adapt to training, and then there’s effects on the mental capacity.

So, decreases in concentration, irritability, depression, and impaired judgment. So these are all. Incorporated in the RED-S model, which is really good. they’re all caused by low energy availability, so I think that’s where the RED-S has getting more traction because we’re understanding that having low energy availability has more impact on other body systems other than just menstrual function and bone health.

Siobhan Milner

I wanna ask you, how do we know if we’re suffering from low energy availability and if there are specific signs to look out for. But I’m also curious as to whether we can have low energy availability and suffer its consequences without actually experiencing REDS or RED-S.

Katie Schofield

Yeah, I guess it’s a really good question in terms of the severity of the LEA, low energy availability, and it’s the question that we don’t know yet. In the research, in the literature, really there are some papers there that put individuals at a low energy availability state at a certain threshold, and then at that threshold, you do see changes in menstrual function. Before you get to that threshold, you’re probably gonna be seeing changes in your mood- you might be more irritable or you might get more upset at certain things that you normally wouldn’t get triggered. There are other things that I guess anecdotally have come across as the cold, hands and feet that that kind of comes about. And then having menstrual irregularity, so it might be. A change from your normal.

So it might be that your cycle has shortened or it has gotten longer, or it’s become irregular. So you get it and then you don’t get it, and then you get it again. And then I guess further down the track, the more energy deficiency that you fall into, then your periods may stop altogether. And saying that everyone has a different threshold of what they will respond to, and it’s really having an understanding of you and your body and tracking particular symptoms or signs like your menstrual cycle is a really good indicator of where you’re at.

Siobhan Milner

When I was a youth athlete, one of the problems was I had male coaches who would not talk about some of this stuff.

I remember when I hadn’t had my period for many months going to a doctor with my mom and the doctor said to me, it doesn’t matter as long as you’re getting four periods a year. Is there any sort of truth to this in that if we’re getting it at least a certain amount we’re okay, or is it just any deviation from our normal should be considered alarming?

Katie Schofield

Yeah, I definitely think if it’s a deviation from normal and it’s consistently deviated for more than three months, that’s where. You need to seek some professional advice because I think it’s important, like sports clinicians, they’re very good at picking up LEA or RED-S, especially if they are knowledgeable in the female athlete area.

They’re very good at picking it up before even an athlete can. So I think that’s really important to know in terms of the comment of, as long as you’re getting it four times a year, I believe maybe it’s, it’s not true, but that’s now being flipped. Whereas if you haven’t had your cycle for more than three months in a row, then you need to seek some help about that.

Siobhan Milner

So obviously we’re talking a lot right now about menstrual cycles as well. And obviously this old terminology, I guess, of female athlete, athlete triad is quite sex-specific. I have seen a few papers out there on RED-S in Men. Is it common or as common in male athletes and does it differ in its presentation in female versus male athletes?

Katie Schofield

Yeah, it’s, that’s a really good question and that’s, that’s, I guess the other aspect of the RED-S model, which I didn’t say earlier, is that it is inclusive of male athletes and I think that’s a really good conversation to have. Men do experience low energy availability, and they do experience the effects on body systems and performance.

So it’s becoming talked about a lot more. Is it more common? I’m not sure because we are not studying it as much as we are in female athletes, so it’s really unknown. So I can’t answer that specifically. But we are seen in the media. Male athletes and particularly male cyclists are coming out and runners are coming out saying, yes, I’ve experienced RED-S.

It’s an interesting one and I feel like the male athletes, they probably have a much lower threshold than what female athletes can tolerate in terms of low energy availability. So it takes a male athlete probably longer to have issues than a female athlete would. So in that sense, it’s probably harder to catch In a way, what I’m hearing other researchers say are signs and symptoms.

For men, clearly, they don’t have a menstrual cycle. So what is kind of the equivalent? That a male athlete can look at that doesn’t involve blood tests or anything like that. And that can be like their morning erections. Is that going, like, is, is the number of that reducing? How is their libido, what’s their fatigue like?

And then it’s still those same signs and symptoms of how, how many injuries or illnesses are they having in a season? And is that number increasing? And then also performance. Are they adapting to their training?

Siobhan Milner

So I just wanna actually recap some of these, these symptoms as well, just so if anyone who is listening, if they’re suspecting that they could be suffering from this, That we can kind of recap them.

So tell me if I’m wrong or if I’ve missed something, but some of the things you’ve mentioned are irritability or poor mood being triggered by things they might not normally be triggered by. If they’re a female, obviously disruptions to the menstrual cycle, increase injury or illness, and decreases in performance.

And as you’re saying, if you’re a male, also changes in sex drive or sexual function. Does the latter also apply to females?

Katie Schofield

Yeah, absolutely. I was gonna say, yeah, libido in females as well. Another thing that I could add on there is gut issues is probably something that you would pick up early. So being reactive to particular foods.

You know, dairy is one, or gluten is one that, you know, athletes tend to then take out their diet and then unintentionally don’t replace the calories that. What foods would have typically equaled in terms of their energy intake, and then that increases their energy deficiency. So it can be a vicious cycle, especially if you are doing it unintentionally.

And that’s probably something that I should talk a little bit more about low energy availability, is that you can create low energy availability by intentionally reducing your energy. So that might be through. eating disordered behaviors, so anorexia binging, purging, using medications, things like that.

That’s where you need more professional help and psychological help for those issues. The majority of athletes just are unaware of how much nutritional intake they actually need, and especially when they have an upswing in training, whether it’s volume or intensity, and they’re not accounting for that extra energy that they’ve expended in training.

Their nutrition, and that’s where they can fall into this low energy available state. So, that’s, there’s something to be mindful of for athletes if, you know, if you’ve got a big training block, well you’ve gotta be eating more just, just to make things match.

Siobhan Milner

Yeah. Because I know, well, I think for me, when this happened, it was.

A case of a really high training load and I felt like I couldn’t actually stomach enough food. That was one of the big troubles for me.

Katie Schofield

Yeah. I just wanna touch on the ‘how you couldn’t stomach food’. When we train hard and we train long, our body has all these hormones working, and then one of the things that happen is our appetite hormones get down-regulated.

So that’s just the body’s down-regulation of our appetite hormones. And so that’s just like another big risk factor for low energy availability, right? Because you don’t want to eat. This is the time when you really do need to eat, ’cause you need to recover from that really hard session. So I guess the key thing that created my RED-S was this fixation on powder weight and being light and lean.

So being a starter for Team Sprint. So, my event is done under 20 seconds, so I need fast acceleration off the line. So that’s where the powder weight kind of came into play. and at one of the world champs, I was producing the most power that I’ve ever done, and I was the lightest and leanest that I had ever been after those world champs had some time off and I, I put on some body mass and, and body fat fit, but my performances were not as high, and so I.

Silly of me when I think about it, but I was just, oh, it’s just because I’m a bit heavier. So if I could get my powder weight back to where it was at Worlds, then I’ll be, I’ll be performing better. But what was happening was because I was limiting how much food I was having, I probably wouldn’t say limit.

The amount of food, it was probably the density of the food. You can have a higher volume of food and be seen as having lots of food, but if it’s low density like lettuces and salads and things like that, then you aren’t gonna get the full energy intake. So yeah, it was just a progressive drop in body weight and body fat that I started getting irregular periods and it just got to the point.

I, I pushed that all aside because I was training hard, racing hard. I didn’t wanna miss out on key international events, so I pushed my body even harder, trained even harder because I wasn’t performing well, so you know, all the wrong things to do. The breaking point was when I didn’t get selected to be in the team for the year. And at that point it was like, okay, I’ve really, I know something is wrong because I’m not getting my periods. And so I sought medical help and then they, they told me about, well, you’ve got RED-S and I was like, what is RED-S? So that’s kind of how I, I started to learn about it and then, Working through with a full team around me, which I think is really important for athletes to have worked through and just realizing, yes, I’ve got to eat more so that I can get my menstrual cycle back so that doesn’t have an impact on my bone and, and that, but the biggest thing was I wanna get back on the team.

What Do I need to do? Well, I need to get my menstrual cycle back ’cause I, I knew from a science background that’s gonna help with the hormones for me to gain more muscle mass, to get stronger, to get more powerful. So that was my driver to get better and then was able to get back on the team, which was fantastic.

And then that’s how it led me down this whole research pathway.

Siobhan Milner

Do you feel that coaches and training staff are aware enough of low energy availability and RED-S?

Katie Schofield

I believe in New Zealand, the coaches are a lot more aware of it, but in saying that, I still feel, yeah, the message needs to be heard a lot more.

It can be a tricky situation to have a conversation, I should say, to be honest, in New Zealand. And the work that I’ve done with my research and even with my supervisors, the awareness is, is growing. But I do feel that a large percentage of our coaches, who unfortunately, a majority of them are male, don’t see the value in understanding or even being aware.

of the consequences of lower energy availability or RED-S. And I say this because some of the comments that I hear from athletes or their practices that they suggest for their athletes can be really detrimental to them, both male and female. And it’s just because they don’t, they haven’t been exposed to this information and don’t have the full understanding or education. It’s, it’s kind of, it’s really the coaches and the athletes that don’t want to know about low energy availability or readiness that most likely need to know. And it’s like, how do we reach these individuals? I’ve presented at some conferences and there are coaches that sit in the back.

And they kind of huff and puff or, you know, they cringe about how many times they say the word period and like they don’t wanna be in the room. So it’s like, how do we get those messages to the people to see how. How valuable this information is, and how valuable it will be for them to know to help their athletes perform so much better.

So it’s, it’s a continuing conversation that I consistently have with individuals that I do presentations too because the ones I do presentations to, they wanna. Like they wanna know more, but really we need to reach those people that don’t wanna know and just don’t, don’t see value in it.

Siobhan Milner

I’ve definitely worked with other male coaches who sometimes I’ve felt like it’s just kind of a, a hands-off approach, especially when there’s sometimes things like disordered eating involved where they feel awkward about broaching it and then of course, when it’s a female athlete and it’s periods, there’s still a lot of men who are scared to talk about menstruation when it’s these people that don’t even want to engage. I don’t even really know how we can open up the conversation. I guess the thing could be coming at it from a really physiological standpoint because I think even for me, I once had someone tell, You know, ’cause obviously, I’m in strength and conditioning, and strength and conditioning is a really male-dominated sphere. And I’ve talked to people about how this can sometimes feel tough and I once had someone tell me, yeah, but as a female coach, you’re really valuable to female athletes. And I’ve realized since looking at stuff like RED-S I was like, I don’t think I was that valuable because I knew the same stuff that all the other male coaches knew when it came to coaching and working with female athletes who might suffer from some of this stuff. That’s a little bit of a tangent, but…

Katie Schofield

No, I think it, it’s a valuable point I could imagine. It is a difficult space and difficult conversations and can be awkward for some men to have these conversations with women. But I think you’re right. If we can do it from a physiological point of view you know, get the most out of your training, then maybe that’s tangent. You know, I think slowly we are starting to make the change. It is a long slog, but I think we just have to keep sharing and, and bringing those coaches that are doing, or having or taking the proactive approaches, you know, to prevent their athletes. going into low energy availability. We need to bring them to the forefront and, you know, champion them really.

And there are some great coaches, male and female, who have got the female health first before their performance. Especially in New Zealand. So yeah, like we are writing a paper about these coaches, so watch out for that. Oh, cool. At the moment. Yeah. So yeah, I think, I think we can definitely do better across the board for all our athletes.

We are getting there, but yeah, it just takes time and, and more awareness and you know, things like your podcast and stuff like that where these messages are getting spread, you know, we will create the change

Siobhan Milner

A Lot of athletes that I’m working with, especially young female athletes, are getting more interested in things like time-restricted feeding and intermittent fasting.

For me, at first, I was thinking, okay, you know, if they’re doing some of the easier, maybe circadian rhythm fasting where it’s 13 hours or 14 hours. Okay, sure. But then I realized that especially for these athletes who have multiple sessions in a day and training late at night, some of them are now hesitant to even eat after training at night.

I’m getting a little concerned about low energy availability around this, and I think is one of your supervisors, is it Dr. Sims? Stacy? I’ve been reading her book as well. So now I’m like reading a little bit more about fasting in women, because before I’d only ever read general science, but I guess what I would like to know is, do you have any particular concerns around athletes using time-restricted feeding?

And do you have any particular advice for athletes who want, who want to use that? But how they can prevent low energy availability or do you take a particular stance on the use of this for athletes?

Katie Schofield

For me, it’s followed by more questions from my end. It’s, I guess, the first question to ask the athlete is why they want to do time-restricted feeding, you know. Is it for health benefits? So say they might have a metabolic disease, so type one diabetes, for example, that’s shown to help with stabilizing glucose levels. That could be an avenue or is it for weight loss? If it is, then I, I say don’t, don’t try it. And are they actually knowledgeable?

About time-restricted feeding, you know, and are they seeking professional help with a nutritionist or dietician to help that? I only have these questions in the forefront of my mind, just because if they’re uneducated or knowledgeable, what time restricting feeding is and what it, what it can do, then are they just following a fad? So what I find with individuals, if they’re athletes or not with time-restricted feeding is that they effectively end up limiting not only what they eat, but the amount that they eat. So time-restricted feeding is not both time-restricted feeding. Just having a greater window where you are not eating, but when you are eating, you are eating the same amount than what you would throughout the day.

Does that make sense?  But most individuals will end up because they’re missing a whole main meal, they won’t replace that in their feeding window. So that’s where they fall into that trap of low energy availability. If they’re not having the amount. Yeah. You touched on fasting for females.

I guess my stance is, I don’t guess, like my stance on fasting for females is that it’s, it’s not appropriate for athletes, especially with females. Just, you know, if you’re fasting, your body, you know, increases in cortisol and then that’s a stress response. . And then if you’ve got a high-stress response because you are not feeding and you put training on top of that, you’re gonna increase that stress response even more.

And our bodies can handle that from time to time, but it can’t handle a consistently high level of stress. And that’s where we fall into issues. I guess the other comment of time-restricted feeding, so say your example, like you had a 12 or 13-hour window overnight. If athletes are having to get up really early in the morning and they fasted for that 12-hour window, and then they go straight into training, they’ve got nothing on board to use for their training, then it’s gonna go to other, you know, the body is going to draw on other systems of energy for them to exercise.

That’s not really gonna help them get the most out of their training and it’s gonna ruin their recovery. , same thing at nighttime. If they’ve got a late practice and they come home and it’s like seven o’clock, oh, I can’t eat because I wanna do a seven to seven hour 12 hour fast, then they’re limiting their ability to recover from that session.

How does an athlete expect that the next section, the next morning or the next day is gonna be better? , you know, they might feel better because they’ve got less gut disturbance or you know, or that, or they’ve had a really good sleep. But f from a post-training recovery meal, it’s gonna be hindering

Siobhan Milner

A lot of the athletes I see that are wanting to do this, like you say, they’re not necessarily following the advice of a dietician or a nutritionist, and some of this comes from, Funding really, that they’re, they’re in certain, even, even if they’re in Premier League, depending on who’s, who’s paying, what sport it is, sometimes they don’t have access to a nutritionist.

Sometimes they’ve only got their main sports coach who has to wear all of the hats, and so this is where they kind of go rogue on some of these things as well. Again, this is kind of coming back to like, I guess the sporting coach side and how we do things, but it’s really. Yeah, we’ve gotta know about all of these things and try and wear all the hats sometimes.

And that can be really tough.

Katie Schofield

Yeah, a hundred percent. And I feel the coaches are expected to know a lot and have all those hats, especially at a development level, and a majority of the time they are volunteers. Right. It is a tricky, tricky space. But then, I mean, people love to help people, you know? So if you find that you have an athlete that might be going down this road, then pull in someone and say, Hey, would you mind giving an education session to my group?

Just because I think it’s, it’s important things. I don’t know. Have, have you come across any ideas to get…?

Siobhan Milner

No, I guess I’m thinking about it in particular because I am working across different levels. So like I’m, I’m working with some people who are in the high-performance pathway, who, they’ve got everyone at their disposal, right?

And then I’m working with some other athletes who, they’re really only a tier below, but it feels like a world of difference. You know, being in those regional teams that feed into the national team, but if they’re not consistently in the national team, they sometimes just get totally different. Yeah, totally different support.

I’m always, I guess, thinking like, yeah, it’s, in a way it should be easier at that elite level. Because they have people dedicated to nutrition people dedicated to the s and c people dedicated to the sport. Everything, the mental skills, the psychology. But yeah, there’s, there sometimes just seems to be.

This huge difference, even just one tier below. I don’t know. Do you, do you feel like you see that difference between levels in New Zealand?

Katie Schofield

Oh, for sure. Definitely see it in levels, and I, I feel organizations, sports organizations are getting better at this as they, they’re wanting to funnel more athletes.

Into an elite program. So they’re building development programs to have more support. But yeah, even you are right, there is a difference in levels of support from development to the elite. It’s really, I don’t know, I guess I’m challenging the sports organizations to, you know, look at the funding that they’re using for the elites and providing some services and support for those that are in the development stages, just so that by the time they get to Elite, they’re in the best shape, best position, best health that they can be in.

And then in the Elite program, they just run away with them because I believe it’s the development athlete. Where they can run into risks. And I’m just thinking the long-term health consequences of low energy availability are bone health and osteoporosis. And we kind of wanna prevent that. For females,, if you reach 20 years old, you’ve already put down your peak bone.

Or your peak bone density. So that’s how strong your bones are. And from that age, we just have a natural decline in bone density. So if we are getting athletes who have been over-training or not fueling appropriately throughout those peak times before their 20 to lay down the bone density. The best bone density that they can have.

If they don’t reach that peak over time, you know, by the time they get to 40 or 50, they might be having signs of way more stress fractures or way more injuries that all played a part back when they’re, you know, in their teenage years. And that could be a little bit scary to think about. The other side of the coin, I should say, is athletes at that age.

And I, I myself, I didn’t care about how I was gonna be when I was 50, 60 plus. I wanted to be the best that I could be, you know, on the world stage, regardless of, of my, my health, you know? And that’s a dangerous space to be in where I was putting my performance above my health. So I guess it’s just the awareness and coming back to the full circle of, you know, we really need to make sure that we are looking after the younger athletes so they’re not only good and, and healthy as an elite athlete, but then further on in life.

Siobhan Milner

If you’ve experienced RED-S or low energy availability, does that put you at higher risk to experience it again?

Is there anything like this? Are there people who are more predisposed to it as well? I wonder.

Katie Schofield

If, if you have an athlete who’s been in a low energy available state or RED-S for a very long time, then they’ve probably ingrained some habits that are quite hard to break. And so that’s. Probably where you need more of the psych help, the nutritional help to, to help break particular thoughts or, or feelings about either food or training and body image to help that.

And then I guess in terms of who’s at more risk, everyone is at risk to some degree, but there are sports that are at a higher risk. So that’s where your endurance sports come into play or sports where leanness is a factor for your performance. If you have to look a particular way, like gymnastics, the aesthetics type sports, like bodybuilding and things like that, or sports where you are having to meet a weight target, lightweight rowing, weightlifting, judo, those types of.

Yeah, so I would say that anyone is at risk, even recreational athletes can be at a risk. Like I’m, I’m seeing a lot of busy moms, you know, who have full-time jobs, juggling kids, still working out a lot, but might be training for a 10 K might be missing recovery. nutrition because they’ve gotta go pick up the kids or they’ve gotta prep dinner and they’re just go, go, go, go.

And they don’t really look after themselves first. And that’s, that’s where we have been seeing more, I guess, athletes coming with low energy availability or getting sick more often, or injured more often. Or for females, their cycles, just come irregular.

Siobhan Milner

Do you know, or do we have any idea in the literature what percentage of athletes suffer from either LEA or RED-S? Because I feel, even for me, as someone who’s active, when I hear a lot of these symptoms, I can check a lot of them. And so, you know, I wonder when we know if. Okay, now I’m getting into two questions. When do we know if we’re just kind of fatigued or if our loading needs changing, but also how common is this?

Katie Schofield

Yeah, I would say it’s quite common and we probably don’t know the full picture either because of the populations that we’re actually researching. So really we’ve been researching recreational and it can be quite considerably high. I think there was a research study done in 2015, something like 67% of recreational female athletes were at risk of RED-S, weren’t diagnosed, but were at risk.

Yeah, it’s huge in the recreational population. And then in terms of like elite population with, with my project and the females, I had close to two thirds, again, have experienced. Be categorized as low energy availability. But I, I want to, I want to say though that with my project, it was one point in time, so we, we don’t know if they might be low energy availability just in that state that I tested them in.

They might be fine for the rest of the season, but yeah, so I guess there is some limit. To each of the researchers that that’s been done. You know, and, and because there is such a high risk in terms of endurance sports or sports where they’re running or jumping, they tend to be researched more.

So we don’t really, I think we are learning more, but we probably don’t know the full picture in terms of other sports.

Siobhan Milner

So if someone has been diagnosed with or has symptoms of RED-S, what are their next steps and do they need to stop? Training or racing, or can this be managed in tandem?

Katie Schofield

Yeah, I think if you have symptoms, I really strongly recommend you seek a sports physician just so that you can rule out other underlying conditions.

So we have to be mindful that these symptoms can run in. in conditions like hypothyroidism, pregnancy, menopause, and so I think it’s really important that those things are ruled out first before you get the readest diagnosis. Yeah, so if they’ve been diagnosed with it, again, it depends on how long they’ve been in that readest state and what the severity of their symptoms are, and you really have to understand the individual as well.

So clearly if they have a stress fracture, and for them to continue training, it’s gonna do more harm. So yes, you’ll have to reduce the training there. It’s really working in a tight-knit team. So, if you have been diagnosed with radius or low energy availability, then it’s advisable if you can have support.

Your sports doctor, sports physician, a nutritionist, just to make sure that you are having enough nutrition to meet your daily needs. One, but then what you’re doing in training as well. Some sort of mental skills coach or a counselor just to help process ’cause a. Athletes, you know, they might have this preconceived idea, if I stop training and I’m told to eat more, I’m gonna put on weight and I don’t wanna put on weight because I wanna be, you know, the athlete that looks lean, that looks fast.

You know, so those thoughts can be counterintuitive and might prevent the actual recovery process if that’s, you know, the thought pattern. Yeah. And then, so sports physician, nutritionist, or dietician, mental skills person and your coach, and your other supporting members, whether it’s a friend or your family.

I think it’s really important to have that supportive environment where they’re all there to help you get better and get back to competing at a high level.

Siobhan Milner

What if you’re a recreational athlete or an amateur athlete that doesn’t have that big support, or maybe you’re in even an individual sport and you’ve only kind of got your coach, then is it just we start with the physician or are there any particular ways you’d kind of change that advice?

Katie Schofield

No, I, I think your health is your number one priority in sport and, you know, we can be, I guess we can be a little bit like magpies like we want the greatest equipment, we want the, you know, the new shoes or the new, you know arrow helmet or something like that. But, and, and we’re happy to spend that money on the equipment, on the new toys, but, we are probably less likely to spend that money on ourselves.

Mm-hmm. in terms of health. So I, I don’t know, I, I put a challenge. It’s like you wanna get. , you wanna have the machine running as well as you can like you get your car serviced each year. You need to make sure that your body is serviced well. So would I, would I change what I’ve suggested? Well, initially, if funds are low, then yes, medical support is needed.

And then working with a nutritionist, just, it could just be a one-off session just to make sure that you are having enough and quality. quality foods. In terms of what I could offer advice for the coach, it’s probably reducing the training. So if they’re not injured, okay. I still think it’s important to let athletes be athletes, but back off the training volume and intensity and, you know, for athletes, all they love to do is exercise.

Perform better. So would it do more harm to take that away and tell them no, they can’t exercise? You know, I think there’s no black-and-white answer. It’s, it’s very individualized and that’s what makes RED-S quite complex and exciting too. And that’s why I love this space, everyone is individual.

And if an athlete who is told they can’t exercise at all, given that they’ve got, you know, no major injuries to, to prevent more harm, I mean, sorry to create more harm, then I think. . It’s good for their mental state just to be moving, you know, to be doing something. It might be just going out for a walk. It might not be doing an actual training session.

It’s just activity. Activity is another way to reduce the stress and the low in the body just so that it can recover and repair. You do have to really know your athlete. Like I’ve, I’ve come across some athletes where they’ve been given a training program and the training is intense, but then a coach hasn’t realized they’ve actually been biking a considerable distance to get to the training session and then bike a considerable distance back home, you know, that’s an added level of training that’s not in their program, is extra calories that they’re expending, you know? And if they’re wanting that athlete to reduce the training, then you really have to have eyes on everything. And that’s where having that rapport with your coach and your team around you is so vital to be open and honest about.

so that, you know, you have to really face it head on, and it takes a lot of courage to then go, okay, I’ve got this, this syndrome, let’s tackle it. Let’s do it. Let’s turn it into a positive. You know, and this is the type of thing where these conversations can be all doom and gloom, but. There are so many athletes now that have had LEA have been through these and have come out the other side just so much stronger and faster because they’ve, they’ve really gone into understanding not only the condition, but what triggers them and, and how they can improve.

Yeah. And so I think it’s really empowering. So I get really excited about it.

Siobhan Milner

Katie, I’ve been keeping you a long time, so I’m, I’m gonna ask you where people can find you and if there’s anything that you wanna highlight.

Katie Schofield

Ooh. Okay. Where they can find me, they can find me on Instagram. I have a website, https://www.katie-schofield.com/.

And what do I want to highlight? I think the biggest thing for me that I tell athletes is to track a diary of their menstrual cycle for females, for males, I would say libido or morning erections, and just every morning write down. So you have those, those two measures, of tracking, but your mood is one.

How upbeat are you feeling? Are you not feeling that upbeat? Fatigue levels are another one. So, and just keeping it simple, just track them every day. And then if you see a pattern that’s going down a rabbit hole, then it’s like talking to your coach. And just seeing, okay, maybe am I adapting to my training as I should be?

Maybe not. Okay, so let’s look at maybe the reasons why are you fueling enough? Have you got your nutrition dialed for during and after exercise? And are you getting adequate sleep? Cause sleep is a massive component of recovery and performance.

Siobhan Milner

Absolutely. Thank you so much, Katie.

Katie Schofield

Thank you, Siobhan. It’s been lovely chatting.

Siobhan Milner

Thanks so much for listening to today’s episode. I hope you enjoyed it. Just a reminder that you can find further podcast episodes at http://www.siobhan-milner.com/podcast and this is where you can also find different ways of working with me. Enjoy!