REDS - Post by Katherine Wood
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 in the summer of 2017 after studying for my undergraduate degree in Biochemistry at Oxford University 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, which, when combined with my perfectionist tendencies, high-achieving nature and extreme determination, meant I rapidly transitioned from losing some weight accidently 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 (without parental nagging I clearly wasn’t able to cope or manage myself nearly as well as I’d thought) and 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 and I was able to start running more seriously again. I ran my first half marathon in 1:41 in 2015, and completed my first marathon (the Bournemouth Marathon) with my dad in October 2016, in a very 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.
Fast forward to spring 2018. Having completed my first ultra-marathon in September 2017 and joined Sale Harriers in October 2017, I had taken huge amounts of time off both my half marathon and marathon PBs, which were now sitting at 1: 23 and 3:05 respectively. My focus was now on the London Marathon. All the training was pointing towards a massive PB – I had never felt fitter and stronger, and at the Surrey Half Marathon in March I smashed my PB to run a 1:20 and scoop up the silver medal, coming in just behind fellow Sale Harrier Jenna Hill. My training volume had 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. However, London was not to be. The freakishly hot weather, combined with the huge amounts of pressure I had put on myself, meant that things did not go to plan, and from mile 16 onwards my only goal was to get round the course and cross the finish line. In this I succeeded, clocking a time of 3:06. I was bitterly disappointed – I knew I was capable of so much more than this, and it felt like I had let both myself and my club down. Looking back, I acknowledge this was a load of twaddle – of the many Sale Harriers who had run in London, only a couple of runners came in anywhere near the time they had been hoping to run – but after months of hard training it was hard to reconcile this in my head. So, what to do next? Obviously, find another marathon in the not-too-distant future and do it again to prove that I could. Over the course of May and June, I raced virtually every weekend as well as taking part in local evening races, winning several events, smashing my 10km and 10-mile PBs and completing my second ultra-marathon. I upped my weekly mileage further, increasing the number of double run days, adding in extra exercise bike sessions and core exercise sessions into my routine, trying to fit all my training and racing around my PhD work. In July, my partner and I travelled to Bavaria for our summer break, as I had entered the Königsschlösser-Romantik Marathon, a picturesque and mixed-terrain alpine marathon taking in the sights of Neuschwanstein Castle. The result? I was the winning female and 7th overall, with a massive PB of 2:49, not only finally breaking the 3-hour barrier but also the 2:50 hurdle. I was over the moon – this was what all those hours of hard training had been for. Clearly, my ever-increasing training volume combined with competing more regularly than ever before was paying off. I felt invincible.
While delighted with my performance in Germany, I knew the course had been mixed terrain and not entirely flat – on a flat city marathon course, surely I could do even better than that? Therefore, I decided to enter the Yorkshire marathon in October, with the Scottish Half Marathon and Robin Hood Half Marathons in September as my key training races in the lead up. Because the combination of increased mileage and cross-training seemed to have been successful so far 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 (as well as running the Thames Meander Marathon in 2:51 just three weeks after my marathon in Bavaria as a ‘training run’), and was 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 of 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, most likely the result of open and infected insect bites that weren’t healing well. I was put on a course of antibiotics which helped to clear the infection, 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.
With the clearance of the infection, I decided to still give the Robin Hood Half Marathon a go at the end of September. It was two weeks before the Yorkshire Marathon, but having missed the other race and it doubling as the England Athletics Half Marathon Championships, I really wanted to race it (particularly as I had been given an elite starting place). I didn’t have great expectations of myself; while I knew I had put in a huge number of miles and was capable of a PB on a good day, the cellulitis episode was still fresh in my mind and I felt less prepared than I would have liked. But I cast these doubts aside and the race could not have gone better. Allowing myself a relatively steady start, I found myself as second place female as we conquered the first rather hilly few miles of the course. But as the terrain flattened out and I could see my opposition ahead, I knew I had it in me to push up the pace and I started chasing her down, before passing her at mile nine. With the threat of being overtaken again playing on my mind, I was able to drive myself through the last four miles, crossing the line in a two-and-a-half minute PB of 1:17:34 and winning the EA England Half Marathon Championships!
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. I was running so well 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 having weeks with a lower mileage, and having not tapered ‘properly’ for events in the past, it didn’t seem worth doing it now. And so, with warnings from others that ‘if you crash at mile 20, it’s your own fault!’, I went into the marathon on the back of an approximately 80-mile week. But, as with the Robin Hood Half, things couldn’t have gone better. For the first few miles, my major aim was to stick with Julie Briscoe for as long as I could, a seasoned marathon runner with a PB considerably faster than mine; I knew if I tried to match her pace I was on for a good time. As the two leading ladies, we fell into a comfortable pace in a small group of men, and I surprised myself at how relaxed and steady I was feeling. But as we approached some undulations on the course, I realised that I could push myself harder and so I pulled away from the group, taking the lead position. My pace was extremely consistent, and despite both pouring rain and huge amounts of standing water underfoot, I felt great. By mile 20, I knew I had several minutes on Julie and although I was beginning to really feel the cold and wet, I pushed myself on – I didn’t want to lose this now. The last few miles were a bit of a blur – I knew I was on for a PB, but being too cold and drenched to look at my Garmin, I had no idea what time I was going to cross the line in. Finally, coming up the (very unwelcome) hill to pass the 26-mile mark, I could see the electronic timer above the finish line, and as I crossed the line to win my watch said 2:41:33, a huge PB and the biggest running victory of my life.
By this point, we were midway through October; time was rapidly passing and things were beginning to take a turn for the worse. Following the marathon, I was on such a high that I didn’t give myself any sort of recovery or rest – I was back to a normal training week the day after the race, and was still pinching myself as I watched myself on the television highlights of the marathon. Furthermore, Liz Yelling had also agreed to coach me remotely, something I was over the moon about.
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 being almost over 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. While I made some changes to my diet to increase the calorie intake, this was never going to be enough to sustain the training workload I was imposing on myself, and deep down I was very aware of this but kept telling myself if I left things as they were, everything would sort itself out. All of this was beginning to really take its toll on me. I was exhausted all of the time, I could barely keep up with my normal group at the club track sessions I went to, I was struggling to complete Liz’s tempo sessions, I was avoiding situations if they would clash with training and I was losing interest in everything else going on in my life. 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.
In mid-December, my fiancée and I went on holiday to New York, a trip we had planned months in advance. While I had a lovely time and it was a very welcome break from PhD life, it was still dominated by running and worries about food. I had been extremely concerned about getting in enough miles while we were away, which meant that every morning I was running 8 – 10 miles in Manhattan and every evening I would force myself to go on the treadmill in our hotel. The break from normal routine also had an impact on how much I was eating – while I certainly enjoyed proper New York bagels, I was eating even less overall than I had been at home, with the result that 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, I drove down to my parents’ on Christmas Eve and left on Boxing Day. 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, on my return to Manchester I continued to run and run and run; alone for several days while my partner was still with his family gave me too much time to stew and worry and get caught up in my desperation. My hamstring was now very bruised and my whole leg was swollen and painful, the pace I was able to run at was getting slower and slower, and I just felt completely alone and lost.
I remember the day I decided to make a change well. 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. Admittedly, I knew this meal plan was far from perfect as it consisted of ‘safe’ foods that I was comfortable with (only very low-fat and fat-free foods, for example) which meant that I was going to have to eat a lot to make up the numbers, but the most important thing was putting on the weight and at least for now if that meant eating foods I felt comfortable with, then so be it. It certainly wasn’t easy, vastly increasing my food intake so suddenly, but I was still running at least 13 miles a day, plus doing all my other cross-training, so I could rationalise it in my mind. All the while, my hamstring injury was continuing to get worse; despite what everybody was saying about needing to let it heal, I had convinced myself it would improve over time and running on it would help alleviate stiffness and tightness associated with the healing process.
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 I couldn’t do this without any help and expect to recover long-term. The day of the consultation was one of the bleakest day 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 myself 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.
Almost four months have passed since that initial consultation, and things have been a bit of a whirlwind. The mental effort to stop myself from training was hugely draining, and I found it unbelievably difficult emotionally to cope with eating a huge amount and not exercising. Furthermore, a DEXA scan revealed that my bone density had dropped again and was now putting me well inside the osteopenic category, likely the result of a lack of oestrogen. However, I have steadily gained approximately 6kg of weight, my blood CK levels have fallen right down into the normal category, my immune system is slowly returning to a healthy state and I feel a million times better than before. I am now back to training most days, including one track session with my club a week, and instead of doing vast amount of exercise biking, I have been going to yoga and pilates classes which have will be tremendously valuable for injury prevention and general strength and conditioning. I feel like I am coming back stronger than ever, and now I am properly fuelled, incorporating rest days into my schedule and not continuously injured, who knows what I might be able to achieve. Until my periods return, I know I can’t be signed off as completely healthy and recovered, but I am also aware this might take a long time because I don’t remember when I menstruated normally and have been ill for such a long time. In the short-term, the plan is to go on hormone replacement therapy (HRT) to help boost my oestrogen levels and improve my bone density until my body starts functioning as it should, but there have been a lot of hoops to jump through and issues with my GP practise agreeing to prescribe this, even though a private endocrinologist has written to them explaining the situation, and shown them my bone density results. It has been almost three months since we started to initiate the process of getting HRT and it feels like we have hit a brick wall. Perhaps this highlights the general lack of specialist understanding of sports-related eating disorders among general practise, as well as the discrepancies across the country, as my endocrinologist has not had any issues with other regional NHS providers prescribing HRT for athletes in my position.
The availability (or lack thereof) of services in the NHS has really shocked me. 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 the waiting times, I was told that because I had been put onto the fast track system due to the lowness of my 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 recovery is like a marathon, long, uncomfortable and painful at times, it will be worth it and 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. I am more than an eating disorder and I am also more than an athlete – people love me for who I am and the memories that we have shared, and not because of how many trophies I have or how many races I have won. This is one of THE most important things I have taken away from the last few months. I am lucky to be surrounded by a very supportive family, my partner and people who care about me. While I am an athlete and I both love and am very good at running, there is more to life than sport. There is no reason why I can’t enjoy running, and hopefully excel at it, and do other things at the same time. It is vital to have balance and variety, and running is not the be all and end all.
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. Equally, if you are worried about yourself and don’t know what to do, please reach out for help. Talk to a friend, your coach, your family, go to your GP, look at the TRAINBRAVE, BEAT or Mind websites. Believe me, under-fuelling and being underweight will NOT improve your running long-term; if you are living in energy deficit, you can’t build up muscle and therefore get the maximum benefit from training, and you will never perform at your best if you don’t have enough fuel to keep you going. Being constantly tired and getting injured constantly are major signs that your body is not keeping up with the training load and that you aren’t taking in enough to balance your output. Similarly, periods stopping is NOT a sign that you are training hard enough, it is a sign you are training TOO hard and your body is not coping. Please do not ignore these signs. If you want to have a long, happy and healthy career as an athlete, you must give your body the respect it deserves and listen to what it is telling you.
I hope that by sharing this, I can help other athletes avoid having to go through what I have been dealing with over the last decade. I would not wish this upon my worst enemy, and too many sportspeople are having their lives ruined by eating disorders. We need to break the taboo around the subject of RED-S, anorexia and sport if we are to tackle this issue head-on.