RED-S (Relative Energy Deficiency in Sport) happens when your body doesn’t have enough energy to support both basic function and training load. The typical patient is a young athlete who is severely restricting calories. I was 125 lbs, eating at a 300-calorie deficit, an experienced athlete and coach… And had no idea I qualified. I thought I was just dealing with perimenopause.
In my case, the calorie restriction was very modest. A simple 300 calories which equalled one snack. My training load included 4x weight training sessions of 30 mins each and 3x Zwift sessions of 30 mins at a moderate pace and one weekend session of 60 mins in zone 2. When the 300 calorie deficit didn’t produce results, I changed one of the 30 mins Zwift sessions to a HIIT (high intensity interval training) session. That was exactly the wrong thing to do and was the thing that ultimately landed me in a RED-S state.
On paper, I was following a normal weight loss protocol. I wasn’t trying to lose weight per se, I was trying to maintain my weight. I was 125 lbs and 20% body fat. A very healthy range for a 5’3” female. And my training load was what I had done for years. I had also just gained 5 lbs of muscle and I was feeling like I was ahead of the game heading into perimenopause.
When that first 5 lbs of weight gain happened, I thought a modest calorie cut was all I would need. I thought it was the drop in metabolic rate we’ve all heard was part of menopause so I was adjusting my calories accordingly. Most women experience a drop of around 250 calories to their BMR (basal metabolic rate). When the next 5 lbs came, I added the HIIT because that was the other thing I had always turned to. And it was the thing all of the menopause specialists were promoting as the type of exercise to do. Except they were promoting that to the general population, not an endurance athlete with an already high training load.
One thing I didn’t account for was the stress my body was already under from the metabolic changes caused by perimenopause itself. When that was combined with my training load, the modest 300 calorie deficit was identified by my body as another major stressor. That added HIIT session sent me over the cliff. Now my caloric deficit was closer to 600 calories and I had LEA (low energy availability) that sent me into RED-S.
I had symptoms across every single body system simultaneously: Hormonal, metabolic, musculoskeletal, performance, neurological, and immune. What I felt was the soul-crushing fatigue and I blamed that for my decreased performance and strength. The sleep disruptions I blamed on perimenopause and admittedly I started having hot flashes from the accelerated estrogen decline (another RED-S symptom) which I was also experiencing from perimenopause. As soon as that started I went “Oh hell no! We are NOT doing that.” And I called my doctor to start HRT (hormone replacement therapy). That helped, but it wasn’t enough.
On top of what looked like typical perimenopause symptoms I was irritable, my recovery times took longer, I had blood sugar dysregulation, wounds were taking forever to heal, and brain fog. I also blamed the brain fog on the soul-crushing fatigue. Everything was intertwined. Everything also looked like perimenopause, except those are all symptoms of RED-S as well. And I was an endurance athlete who was in a caloric deficit, made worse by an added HIIT session.
HIIT is also the highest cortisol-spiking exercise there is. Add that to the high cortisol my body was already carrying from perimenopause alone and my body declared a full crisis. It stopped trying to perform and it started trying to survive. It also stored what it could as fat.
That’s metabolic adaptation. And it’s the reason why everything I tried made things worse.
I’ll get into that next week.
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