Featherstone Nutrition

Raise your hand if you started running to lose weight and then fell in love with running? That’s how so many of us runners got our start. But, as we increase mileage, add race goals, and try to continue to lose weight – this can get tricky.

When is it appropriate to try to lose weight while running and how do we do it safely and make sure it does not impact our performance and overall health & injury risk?

In order to lose weight, you must burn more calories than you take in (calories out > calories in). This sounds simple, but there are so many other factors that make this much less simple, such as changes in resting energy expenditure, genetics, daily habits, food choices, etc. For these reasons, a weight loss journey will look different for everyone.

First and foremost, ask yourself. ‘Am I trying to fuel for performance or for weight loss?’ These two goals are competitive. If we try to have it all for too long, we increase our risk of injury, burnout, and low energy availability + all the consequences that come along with it. Undercutting nutrition for weight loss is in direct competition with performance. When we consistently under fuel for weight loss, we are not supporting optimal performance in workouts and we sure as heck are not supporting recovery. Think about it – as mileage increases, we need more energy. If you do not eat to support your energy demands of training, you won’t hit paces in workouts. You won’t recover well. You will not replete glycogen stores. You will likely feel fatigued, sore, irritable and performance suffers.  So, if you are in a training cycle, do not cut your energy intake to try to lose weight. Focus on your training, fuel like a boss, and if you’d like to revisit weight loss after your race, go for it!

The safest and most sustainable way to lose weight is to surround your runs and workouts with solid nutrition. Nail your pre-run snack, fuel runs over 70 minutes, and rock that recovery nutrition. Then, skim a small energy deficit across your day. We’re talking small tweaks across the day at each meal and snack. We are not talking about skipping meals and snacks. We do not want large energy deficits during the day. Research has shown that women who cut more than 300 calories per day can experience menstrual disturbances, amenorrhea, lower metabolism, higher cortisol, and lower hormone levels. Men who cut out more than 400 calories per day were more likely to have lower testosterone, lower metabolism, and greater muscle breakdown. 

Hunger is the enemy of weight loss. Controlling hunger is key. If we skimp too much and are ravenous at 2 pm, we will face plant in all the snacks, and overeat later in the day or on the weekends. If you are starting to get hungry… eat something! The best way to stay satiated is to eat balanced meals and snacks. Protein, healthy fats, and fiber will help keep you full longer, so make sure to include one or more at all eating occasions.

It’s no fun. It can feel awful. But many of us runners have been there – having GI distress on race day. We work so hard to train and then get to race day and might experience nausea, vomiting, diarrhea and cramping. What gives? There are many reasons why we might experience GI issues on race day, and we will discuss some of the reasons that I see most with clients who come to me looking for help. Take a look below to see what might be causing your race day GI upset and what you can do to avoid it.

If you know me <The Bagel Queen>, you know that I strongly encourage carb loading before race day. Carb loads can be 1-3 days <or more in some cases>, and the goal of a carb load is to increase your carb intake <check out our carb load calculator> to stock your glycogen stores for race day.

If you are a newbie carb loader, or are unaware of how other ingredients in those foods might affect you, you may need some help choosing your carb-tastic foods.

Early in the carb load you may be able to tolerate more fiber and/or fat in those foods <whole grain bread, veggies, and fruit> you may want to start to choose lower fat & lower fiber foods as you get closer to race day. Simple carbohydrates that are low in fiber and fat <white bread, white bagels, pretzels, juice, etc> will help decrease the risk of GI distress on race day. Although, I do have some athletes who have guts of steel that can tolerate all the different foods pre-race, many of us need to be intentional about what foods we consume in larger quantities.

One of the biggest issues I see causing my client’s GI distress is dehydration. Dehydration can be caused by going into a run dehydrated, not drinking enough fluid during runs, and/or not consuming adequate sodium. If you are a race-day water-only drinker, you may need to consume more electrolytes. If you are a heavy and/or salty sweater, you may need much more fluid and sodium than you think.

Knowing your sweat rate <amount of sweat per hour> and sweat composition <amount of electrolytes in your sweat> will help you understand what your needs are in order to create a race day hydration plan that works for you. Head over to our Hydration page for more information & a general place to start.

What you can do: Start exercise well-hydrated and look into your sweat rate & sweat composition to help meet your hydration needs <we love the hDrop wearable hydration monitor!>

Your choice of race-day fuel & sports drinks can contribute to GI distress on race-day if you aren’t taking them properly. Too much sugar in your GI tract without adequate liquid can cause nausea, cramping, and diarrhea. Most gels require 2-4 oz of water or sports drink to be consumed at the same time to aid in digestion and absorption. Some newer gels <Maurten, Never Second> do not require fluid, due to their specific formulations.

You also want to make sure that you mix your drinks carefully to avoid over-concentrating. Some sports drinks are now made with certain carbohydrates that are able to be concentrated in higher amounts without causing GI distress <like Skratch Clear Hydration>.

We used to think that gels had to be taken strictly with water, but newer research has shown that it’s ok to mix some types of gels & sports drinks, depending on carbohydrate concentration and osmolality.

What you can do: Know if you need fluid with your gels & mix sports drinks according to the instructions, trial & error, and practice.

When core body temperature increases, your body will pull blood flow away from your gut & muscles to cool the skin, which decreases gastric emptying and absorption of nutrients. Core body temperature will likely increase as the length of your endurance race increases – so that’s one of the reasons why I recommend to front-load your nutrition <get it in while you can>. Core body temp will also rise with increased temperature and humidity.

What you can do: dress appropriately for the weather, hydrate well, front load nutrition, ice or cool water in your hat, or down your shirt to keep you cool.

As your rate of perceived exertion (RPE) increases, gastric emptying and absorption of nutrition decreases. Most times, you will feel this later in a race, but sometimes, depending on other factors <temperature, wind, illness, etc.> this might be an issue from the start line. Know your body and know if you need to slow it down for the race to keep RPE lower. This is another big reason that I suggest front-loading your nutrition & carb loading – fuel when you can so you have stores left at the end to fuel your race if you are unable to take in more gels.

What you can do: be aware of your RPE and adjust pace if needed, front load nutrition, and practice your race day fueling & hydration plan during training.

If you need help figuring out what is causing your race day GI issues, apply for 1-on-1 nutrition coaching or Last Minute Crunch Time Session with Meghann here.

The Boston freaking Marathon. We all know it. We all love it. We all want to run it. Well, just like the rest of my race recap below, this is my experience. There will never be a year I ‘don’t want to’ run it. There will always be lessons learned. And, there will always be a way to improve our performance out there.

So, at so many of your requests, here it is… my Boston Marathon recap.

<<and, I think we all know this is my experience – this is not how you have to do it – and this is not a substitute to working on your marathon fueling with a sports dietitian.>>

We all know the party don’t start till I <<re: bagels>> walk in. Race day weekend always starts three days out when the carb load begins. We know that increasing our carbohydrate intake before a race stocks our fast fuel source, glycogen, in our muscles. A full carb load can absolutely save the day out there and allow you to finish your race feeling physically and mentally strong. And, I dunno about you – but a smile down Boylston St is an absolute must in my Boston experience.

FRIDAY – Day One

The carb load started on Friday as I traveled into Boston on an early flight. I was up at 3:45 am eating grahams + chugging coffee so I didn’t fall asleep at the wheel on the way to the airport. Once I got to the airport, I drank a Liquid IV <team watermelon> and ate a Rise protein bar <Use code Feathers10> + Skratch Labs Crispy Rice Cake <team strawberry> as I waited to board. On the plane, I finished a new client plan & stalked my panel guests, Joan Benoit Samuelson & Pam Bede, to make sure I knew everything I needed about them and was ready to moderate the Expo panel with Abbott as our sponsor.

Once I landed, my driver said traffic was horrible and something happened in the tunnel so emergency Skratch Labs Crispy Rice Cake to the rescue. Everyone listen up! This is why I always tell you to pack emergency snacks in your carry on when traveling during a carb load. The driver also had some water for me which was clutch. At the hotel, the bagel load commenced as there was a half dozen waiting for me in my room. Lunch consisted of a bagel + peanut butter + Greek yogurt. There was a bagel snack in there somewhere. And, I ate a bagel + another Rise protein bar  before we headed to dinner. Well, dinner turned out to be more of an open bar and less of the high carb foods I was looking to devour. So, when I got home at 9 pm you guessed it another bagel + peanut butter + Skratch Wellness as a night cap.

Friday’s Bagel Total: 4

Friday’s Carb Intake: 450 gm

SATURDAY – Day Two

We woke up early Saturday to make our way over to film the infamous Carb Load boxes at New Balance before you all came and ate them all! This meant coffee + grahams in the hotel at 5:30 am. <If it ain’t broke… stick to familiar things during your carb load. This is what I do every stinking morning of training.> When we arrived at New Balance, there were 1000 fresh bagels waiting for us. Legit I thought I was dead & in heaven. So, we of course had to sample one, approved! After we wrapped up our event, we all had another bagel because clearly, we couldn’t let these go to waste – fill up that glycogen tank!

I went back to the hotel and feasted on some of the Carb Load box goodies, graham crackers & animal crackers. I forgot how freaking delicious those Barnum boxes of animal crackers are. Then, I went out to lunch with the Believe in the Run team + Emily Saul <fabulous Sport Psychology Coach>. And, when we ordered I might have slightly frozen and also picked a bagel & cream cheese here. <Clearly you cannot teach an old dog new tricks.> Emily helped me visualize better downhill running tactics so I didn’t squeeze the hand break & heal strike the entire first 7 miles like last year.

At this point, I had one small gig to film & then I could rest my Saturday away in a quiet hotel room without hearing ‘Mom’ 1200x per minute. You are all the kindest & many of you reached out worried about my lineup before a goal race – but let me tell you, being able to drop the ‘Mom’ title for the weekend meant this felt like a laid-back vacation. <Shout out to all the other working parents trying to balance parenting, kids, work, training, & making it look easy – it ain’t.> While catching up on trash TV, I decided to play around with my nutrition choices and see how it impacted my blood glucose. I came to Boston with Abbott and had the opportunity to wear their Glucose Sport Biosensor and have been able to see a minute-by-minute read of my blood sugar throughout the carb load. <nerd alert: fascinating! Disclaimer: I am using this device to gain knowledge on how I can improve my running performance with this biosensor. TBD for more…> As expected, my blood glucose rose quickly after eating bagels, grahams, and animal crackers – as it should. More refined, lower-fiber carbohydrates will do that. But, I’ve got a healthy pancreas, like most of us, so it quickly came right back down into range. These increases in blood glucose are what trigger the storage of carbs as glycogen, aka the goal of this carb load. But, I was curious – what would happen if I ate a high-protein Greek yogurt before eating bagels? This was my chance. So, for dinner, I ate a Greek yogurt and followed it up with 2 bagels + some peanut butter. In theory, the protein and fat should have kept my blood glucose from climbing as high as eating a bagel alone, and sure enough – it did. I mean, you all sit around and do blood sugar experiments in your hotel room too, right?! During a carb load, I’m not sure this tactic is necessary – but if someone feels crummy from fluctuating blood glucose during a carb load, this may be helpful.

Blood glucose experiments completed – finished off my fluids for the day – and hit the hay as a half-human, half-bagel centaur.

Saturday’s Bagel Total: 5

Saturday’s Carb Intake: 515 gm

SUNDAY – Day Three

By this point, I am a walking bagel so ate another when I woke up. <Sorry, grahams – promise we’ll be reunited on race day.> And, I walked my bagel-self over to the ASICS brand house with Believe in the Run for our Bagel Shakeout Run. That’s right. More bagels, baby!!! <No, I am not sick of them yet.> I never got the final head count but easily, well over 500 of you showed up for a 3-mile shakeout + to crush another 1000 bagels. <Do you think the Boston bagel makers are onto us yet?!> I promptly ran up and down the group run trying to talk to as many of you as I could and then crushed two bagels talking with you all.

I left the ASICS brand house as soon as it died down and headed over to meet my Fueled for Boston group at the Fan Fest as our group was sponsored by Adidas and what a better place to meet up & say thank you. Who is shocked that one of my group participants brought NYC bagels for us all?! <cue a 4th bagel for the day!> We stood around & talked all things last-minute nutrition for race day and just really enjoyed meeting each other in person for the first time after 12 weeks together online.

After this I headed back to the hotel, felt a little behind on hydration, so drank 32 oz water with Skratch Wellness and that did the trick. Might as well eat a couple grahams with this too, amiright?! I was lucky enough to enjoy a course preview with Joanie, sponsored by Abbott , at this point and drank another 16 oz water while listening.

By this time it was 5 pm the night before the race, and I still needed 125 gm carbs to hit my target. Good thing I stole some extra bagels from the ASICS brand house – so I took those bad boys & my jar of peanut butter to Thomas & Meaghan’s room to hang out. Meg gave me a new packet of the Skratch High Sodium, and I sucked that bad boy down. And as I choked down the last bagel, I told them I was officially bageled-out. Just. In. Time.

Meg, my running coach, and I briefly discussed race day plan. She told me I was easily fit for a 2:48 – 2:49:59 and to go for it. But, we’re also both smart and know you kind of have to wait and see how those first few miles feel to know if it will be a day or not…

I went back to my room for a good night’s sleep and visions of carb-loaded bagel fairies danced in my head.

Sunday’s Bagel Total: 6

Sunday’s Carb Intake: 475 gm

I mentioned my dinner for the race above, but if you’re anything like me you probably skip to the headings you care about so I’m going to recap it here too.

I’m a big fan of an earlier dinner on race night – just preference, honestly. At 5 pm, I ate two massive bagels dipped straight into the jar of peanut butter. <because why would I find a disposable knife?!> And, I drank a Skratch High Sodium in 20 oz water. <tastes like a passionfruit wading in ocean water> 

Why do I eat so many bagels you may ask?! Because they work for me, and I love them. There is nothing magical about a bagel, other than that they pack a lot of carbs, taste great, and are easy to store in a hotel room. I have brought toasters to my races in the past but this year I just ate them so fresh and so clean, clean.

I watched a couple episodes of Emily in Paris, Facetimed by kiddos, and reminded myself I get to do this. I always sleep great on race night – perhaps I’m too calm about these races.

Gooooood Morning!!!! Let’s do this thang! I woke up at 5:30 am to give myself plenty of time to hang out, drink coffee, take care of business, get dressed, and pack up for the race. I am NOT a morning race showerer. I know this is a highly debated topic, but I wait until after the race to get clean.

At 5:30 am, I ate 5 Honeymaid grahams <full sheets, 2.5 servings>, drank 2 cups of hot coffee with creamer, and got dressed.

I made a game-time decision to ride the school buses to Hopkinton instead of taking the VIP buses. Why you may ask?! Mentally, I knew I wanted to be with Meaghan until the start. She’s 100% my person at races. This meant I had no throwaway clothes with me <VIP = heated bus & school room vs school bus & athlete’s village> so someone is sporting some sweet new kicks, Vuori joggers, and sweatshirt #worthit. We rode the bus and ate grahams again <2 this time> around 7:30 am + I sipped on Skratch Wellness <higher sodium>.

When we got to Athlete’s Village it started raining, so we popped in the porto-pots & headed to the tent. It was chilly so we figured in there we’d have some serious body heat to keep us warm, and we were right. We found a solid crew to sit & hang with until go time. Meg & I whipped out our grahams for a third time & a few guys with us did the same. I ate another 4 grahams & finished my Skratch Wellness .

Race Day Graham Count: 11 grahams <132 gm carbs>

At 9:15 am they herded us like cattle into our pre-corrals in Athletes Village and dismissed us line by line to start the 0.7-mile trek down to the start line. Much like last year, Meg and I were two of the only people who were still in our throwaway clothes – but we knew about the secret stop-off with porto-pots & clothes discard tables.

I hopped into there, put on my racing shoes, discarded those brand new Vuori joggers, grabbed my nutrition and went to the start.

Ten minutes before the start, as I took my first gel – a Maurten caffeine – it started to rain. <and, I’m not sure it ever stopped> The National Athem rang and we were off.

I started the race with a 20 oz Amphipod handheld water bottle with 1 scoop of Skratch Sports Hydration <team strawberry lemonade> and 2 Maurten gels, another caffeine and a regular.

As we bounced down those first couple of downhill miles, we were packed like sardines. I saw Meg and her crew weave ahead to get their pace dialed in. I stayed put. Last year the bob & weave left me with dead legs by mile 16, so I was trying something new this year.

I took my first gel, Maurten regular, at mile 4 <which was about 25 – 26 minutes>. Took a few swigs of Skratch as everyone fumbled at the aid stations – I stayed tight to the center line and cruised. I felt great. Quick check – body, mind, breathing – all felt great.

Mile 8 rolled around in another 25 – 26 minutes and I took my second Maurten caffeine gel <3rd gel total> and again some swigs of Skratch to get that bitter, bitter caffeine taste outta my mouth. Quick check – body, mind, and breathing all felt good.

There was a Maurten depot at 11.8 so I grabbed 2 gels here for my mile 12 & 16 gels, both regular Maurten. I stashed 1 gel in my handheld and kept the other in hand to take immediately. I took down my 4th gel, a couple swigs of Skratch, and again – a quick check. Errr… stomach isn’t feeling too good, but mentally & physical running felt exactly like I was hoping, strong. At this point I start bargaining with myself about if I can really stop to poop on course. As mile 14 approached, I saw an open porto-pot & decided the optics of your sports dietitian finishing the Boston Marathon with poop down her legs was not the optic I was going for… <cue 46-second stop> 

I then analyzed how I was feeling for the next mile. All the normal ’causes’ of GI distress checked out fine, intensity, hydration, and normal food, so I knew it was the antibiotics I took the week prior for a raging sinus infection. I was on a very broad-spectrum antibiotic that kills off the bad germs & all the good germs in your GI tract. Quick check – fitness, the rest of the body, and mentally I felt strong. Let’s do this, Meghann.

I took my 5th Maurten gel at mile 16, just before the steep downhill leading into the Newton hills. This was my fastest mile of the day and I felt unstoppable. Shortly after that gel, my stomach turned again. ‘SHIT!’ I thought. ‘I’m gonna have to stop again.’ I made it into a game and at mile 18 I challenged myself to see if I could PR this porto-pot stop. Checks watch: 36 seconds. Success!

At this point, we’ve got two Newton Hills left, and I honestly forgot this was even happening with the poopscapades. I made the decision here to not take my gel at mile 20 – it seemed like this was making things worse. While this never happens in training, it felt like the right move in the moment. I knew I was fully carb loaded <see above – crushed it!> and I could get through the last 10k on glycogen alone.

Around mile 24 – 25 the skies opened up and it hailed, poured, and gusted some pretty serious winds to the point we all just started laughing. If this isn’t Boston, I don’t know what is!

At the same time, I looked down and noticed my pace had dropped 40 seconds and I felt like I was running the same effort. I thought to myself, ‘this is the wall – Meghann. you need carbs or your pace is gonna continue to tank.’ I was bound and determined NOT to stop. So, I remembered my Freaking True Friday post on swishing carbs in your mouth to improve performance. We have receptors for carbs in our mouths that immediately tell our brain ‘carbs are a coming!!!’ and improves performance. So, I swished and spit that last Maurten gel until Boylston St. And, my last 1.5 miles were back to marathon pace average.

That last minute nutrition decision to hold some gel in my mouth to trigger those carb receptors to convince my body to get a move on allowed me to fly into Boylston St with a permanent smile on my face the entire way.

Despite the two GI pitstops + fueling fumble after mile 16, I was able to finish the Boston Marathon stronger than my 3 previous Boston Marathons.

I finished smiling, happy, grateful, and unbelievably proud of what the human mind and body can accomplish with training and belief in ourselves. And, I finished with a Boston Marathon course PR.

Boston Marathon 2023: 2:52:14

Boston Marathon 2022: 2:56:56

Boston Marathon 2013: 3:28:53

Boston Marathon 2011: 3:25:30

There is not a doubt in my mind that the carb load + fueling early and often saved my race. Things happen. Perfect races are the unicorn, not the norm. But if we can stay mentally engaged, positive about our body’s performance, and focus on what we can control we can accomplish some pretty incredible things! Boston Marathon – I love you, forever and ever.

As I finished, the first person I saw was Ali Feller. I immediately walked over to her and said ‘I pooped twice.’ Apparently, I found immense comfort in sharing this with her. She then hugged the crap outta me, almost. Snagged this sweet finisher photo and they must have noticed the V on my bib and sent me right into the VIP tent where I saw my dear friend and medical volunteer, Tamanna. I got another massive hug – I can still feel her stethoscope in my chest.

I scooted through the VIP tent and out the back door in approximately 5 seconds as I grabbed a medal and saw my hotel across the street. I just wanted to get inside a warm hotel, shower, and let my family know I freaking did it!

After a very long shower, I met some people at the hotel bar to wait for the rest of our crew to finish. I slugged back a protein drink in the shower <shower shake!> + a couple of bottles of water. Your sports dietitian had ZERO interest in carbs at the moment but a glass of bourbon was on tap at the bar.

After everyone finished, we headed over to Joe’s on Newbury for burgers and fries – my favorite post-race meal. My mom still cannot believe I eat hamburgers <I was a very selective eater as a kid> so I sent her this picture as proof.

Every marathon is a learning experience. This is why we become better at running the marathon the longer we stick with it. We also know the marathon is a beast. We can do absolutely everything right and still not have a flawless race. My day is a great example of that – I did everything I always do, yet still had some GI trouble.

Carb Load is Queen. I cannot tell you how many times a carb load has saved my athletes and now me. If we fully load those glycogen stores pre-race, we can rely on these for FAST fuel throughout the entire race.

Fuel Early & Often. Again, we never know what the day will bring. If we fuel our body early & consistently we are less likely to hit the wall. And, much more likely to have a mentally strong race. Carbs make us positive, happy and optimistic when racing.

Keep Your Mental Game Strong. Those fumbles on race day don’t have to break our performance. But you know what might?! Our mental game. It’s easy to hear those negative thoughts and allow them to derail our performance. Focus on the positive facts – my body feels strong, I am happy, I am healthy, I am running the freaking Boston Marathon!

Know & Trust Your Body. We all need a plan going into a race. But, we need to listen to our bodies and adjust the plan on the fly when needed. Nothing is set in stone. Trust your body and adapt when needed.

Have Fun. We GET to do this! And, we do this in our free time!!! If this isn’t fun, then why would we do it?! Focus on why you enjoy this and have the time of your life.

I want to send out a huge thank you to Abbott for letting me join their team for the Boston Marathon, New Balance for creating the perfect Carb Load Boxes for 200 of our runners, ASICS for feeding over 500 runners all the bagels they needed & allowing us to take over their store for a shakeout run, Adidas for sponsoring our Fueled for Boston group nutrition class, Believe in the Run for being my trusty sidekicks in all things running, and to all of YOU for trusting me to be a part of your journey and sharing that journey with me.

Quite a few clients have told me that they’ve started taking collagen instead of their regular protein supplement. The trouble with doing so is that unlike whey, it’s an incomplete protein, which means it doesn’t contain all nine amino acids that your body can’t produce on its own. Collagen is abundant in three aminos – glycine, proline, and hydroxyproline – but is low in branched-chain amino acids (BCAAs), like leucine, that is needed to stimulate muscle protein synthesis and doesn’t contain tryptophan. This is why it can complement a protein supplement but shouldn’t replace it. A study published in Nutrients suggested that you can count 36 percent of the protein in collagen toward your daily total <roughly one-third>, so if your supplement contains 20 grams per serving, that’s 7 grams to include in your macro count.

While plant protein offers a viable alternative to whey, there’s no such thing as vegetarian or vegan collagen because it’s only found in animal flesh that contains connective tissue. In theory, your body can make collagen if provided with all the right building blocks, but supplemental, animal-based protein is what increases collagen synthesis most efficiently in humans. That being said, certain plant foods contain sources that assist in collagen production. Often marketed as “collagen boosters,” these can include amino acids like lysine, proline, and hydroxyproline, minerals such as copper, manganese, and zinc, and, as we mentioned earlier, vitamin C.

Recently, several collagen vendors have started recommending that you shouldn’t put their products in coffee, even though the hot liquid helps the powder dissolve. It’s true that one Polish study found while experimenting with human cells in a petri dish that caffeine inhibited collagen biosynthesis. However, it didn’t stop collagen uptake and because of a lack of human based research, there’s no evidence that the same thing would happen in your body. Other studies have only been conducted on rodents, and it’s unwise to try and project how or if they translate to humans. So for now, I believe it’s still effective to add collagen to your coffee, especially if that’s how you prefer your pre-run caffeine intake & need to take your collagen.

While powder remains the most popular kind of collagen supplement companies have begun offering other forms. Collagen gummies make it a little difficult to ingest enough collagen to meet the effective dose, as the per serving dose is usually lower than a scoop of powder, at around 2.5 grams per four gummies. This means you’d need to munch up 16 to get a clinically effective amount. Collagen creamers are handy for adding flavor and collagen to coffee or tea, but the same thing goes. As they typically provide five grams of collagen, you’ll need to double the serving size to get enough.

Several companies are experimenting with genetically modified yeast and bacteria to produce lab-grown collagen that’s technically free of animal products, although this is still in the developmental phase and as it uses microbes, might not be truly vegan. A few companies are offering a new kind of collagen made from fermented eggshell membrane (the part between the shell and the white inside). It can be hard to tell how much actual collagen is in a proprietary blend that can also include prebiotics and probiotics, but two studies that tested its efficacy found that eggshell collagen supplementation reduced pain and increased flexibility after both seven and 30 days.

Timing: Taking it outside the recommended 45-to-60-minute window before exercise

Amount:  Getting less than the 10 to 15 grams needed to stimulate collagen synthesis 

Using as a protein supplement: Collagen is an incomplete protein and doesn’t contain enough leucine which is necessary for muscle protein synthesis. 

To make the most of collagen’s injury-healing, joint health-promoting benefits, make sure you: 

Complement collagen-rich foods with a supplement. Most people don’t get enough from their diet and studies suggest we could all benefit from 2.5 to 15 grams per day. 

If you’re an aging athlete, suffer from joint pain/cartilage loss, or struggle with connective and soft tissue injuries, a collagen supplement from a trusted brand like Informed Sport or NSF Certified for Sport® may be beneficial.

Be consistent. Find a way to incorporate collagen regularly before you train. 

Give it time. Most studies show it takes around six months to realize the full benefits of collagen supplementation.

For even more in-depth collagen info, check out episode 47 of the Fuel for the Sole podcast. Need help with choosing collagen, other supplements, and dialing in your nutrition? Reach out and let’s talk.

Collagen is the most abundant structural protein, comprising around a third of the total protein in the body. It’s a fiber-like structure that makes up connective tissue and is a major component of bone, skin, muscles, tendons, ligaments, and cartilage.

Because collagen production and uptake both declines as we age – starting as early as your late 20s – it may be beneficial to start supplementing. Production drops more quickly with sun exposure (in the skin), smoking, excess alcohol, and lack of sleep and exercise. Research suggests we may benefit from supplementing collagen as you get older to support your training and recovery. Collagen also has the potential to enhance joint health and function, support injury recovery, and improve the appearance of hair, skin, and nails.

There are three types of collagen: 

Type I – 90% of collagen in the body, including in bones, tendons, ligaments, and skin. It’s found in bovine collagen – which is the most common supplemental kind.  

Type II – Mostly prevalent in cartilage, but a little is also in tendons and ligaments

Type III – Always found with Type I in skin and organs

There aren’t head-to-head studies comparing different kinds, but in a review, Keith Baar from the University of California Davis, noted that hydrolyzed collagen <when collagen peptides are partially broken down into amino acids> is the most bioavailable form.

Cartilage Regrowth

Tufts Medical Center researchers found that when they gave 30 people over 49 with knee osteoarthritis 10 grams of collagen or a placebo for 24 weeks, the ones who took collagen increased cartilage thickness and growth. 

Joint Pain

A group of German nutritionists gave 139 active adults five grams of collagen daily for 12 weeks, and it reduced their knee pain.  Another study conducted at Penn State involved 97 athletes taking 10 grams of collagen every day. After six months, they experienced less joint pain during activity. 

Strengthened Ligaments and Tendons

Australian exercise scientists discovered that combining calf strengthening exercises with collagen supplementation for six months helped Achilles tendinopathy patients increase muscle strength and reduced discomfort. A paper released via the Journal of Sports Science & Medicine tested the ankle function of 50 male and female athletes with chronic ankle instability. After six months of collagen supplementation, they reported that their ankles felt more stable and had reduced their reinjury rates.

Bone Density in Postmenopausal Women

One hundred and two postmenopausal women participated in a study published in Nutrients. Following a year of taking five grams of collagen every day, they had greater bone mineral density, increased bone formation, and decreased degradation. 

Skin Elasticity

A group of Japanese and Korean researchers concluded that taking just one gram of collagen consistently improved skin hydration and elasticity and reduced wrinkling.  

Bone broth: 1 cup has two to five grams of collagen, and the liquid form makes it easy to digest

Sardines or fish with the skin on: Marine collagen is found in the bones, scales, & skin

Gelatin: One packet of the Knox brand has 8 grams of gelatin. It has the same amino acid composition as collagen.

Chicken & turkey skin: It might not sound that appetizing, but poultry skin is a good source of collagen

A collagen supplement can help you get a consistent dose of collagen without needing to prepare a food source. The optimal dose for most people is 10 to 15 grams, so pay attention to the serving size when comparing supplements.

And not all supplements are created equal, and there have been reports of low-grade options being contaminated with heavy metals and not containing what they claim on the label. So look for an option like Momentous Collagen Peptides, which contains 15 grams of collagen and 50 mg of vitamin C and is NSF Certified for Sport®, so it’s guaranteed to be free of contaminants and banned substances. It dissolves well in warm water, and you can add an electrolyte mix before exercise. 

Research shows that collagen works most effectively when you take it 30 minutes to an hour before training or, if you’re injured, prior to physical therapy.  A study published in The American Journal of Clinical Nutrition showed that jumping rope doubled participants’ collagen synthesis levels and when they took collagen with vitamin C an hour beforehand, it doubled again. Baar noted that when trying to increase the durability of ligaments and tendons, combining pre-workout collagen, 10 minutes or less of intense activity, and six hours or more of rest is an effective protocol.

Check back soon for part two, in which we’ll examine if vegan collagen is legit, whether you can mix coffee and collagen, and more!

Intermittent fasting (IF) is an eating pattern where a person cycles between periods of eating and periods of avoiding food <aka fast> for an extended time. Think of the typical diet as a dimmer switch, where we dial down the amount we are eating throughout the day. Intermittent fasting is an on-off switch for eating. 

There are many different approaches to intermittent fasting, as the fasting schedules vary and so do the number of hours. Certain kinds of IF involve time-restricted eating, while others suggest fueling normally on certain days and restricting calories or not eating at all on others. The most popular methods include 16/8 (fasting for 16 hours, eating for 8 hours/day), the 5:2 diet (eat normally for 5 days and fast for 2 days out of the week) and alternate-day fasting.

A 2019 review released via The New England Journal of Medicine concluded that intermittent fasting may help with obesity, insulin resistance, hypertension, and dyslipidemia. The authors also noted that it could increase cellular stress resistance and benefit those suffering from neurological disorders. They suggested that IF might delay the aging process and potentially extend lifespan too, although this hasn’t been proven in human trials. 

A 2022 review in Nature Reviews Endocrinology stated that in previous studies IF has led to mild to moderate weight loss (3–8% loss from baseline) over eight to 12 weeks. However, this is comparable to weight loss achieved with traditional calorie restriction. The authors stated that the ability of IF protocols to help to manage weight long-term is still poorly understood, as the majority of studies to date have run for short durations. They also noted that while some trials have shown that IF improves cardiometabolic risk factors such as blood pressure, insulin resistance, and levels of LDL cholesterol, triglycerides, and HbA1c, other findings contradict this.

Advocates for IF claim that it can improve training and race day performance by making your body “fat adapted” – i.e., able to utilize fat more effectively. Our body prefers glucose at moderate-high intensity for fast-acting energy because it breaks down quicker than fat. It’s important to fuel adequately before and after every training session. For longer runs and races, you’ll perform your best if you fuel during longer runs and races as well.

There’s evidence that failing to do so impairs athletic performance. A paper published in the European Journal of Sport Science found that participants had less power and became exhausted faster when they followed an IF protocol before a cycling test. A team of French researchers found that continual fasting compromised endurance during a 5K time trial, which they suggested was caused by decreased muscle contraction and reduced VO2 max.

As we explored in a previous post, taking in too few calories consistently can predispose you to Relative Energy Deficiency in Sport (RED-S), which can lead to a whole host of problems. These include disrupted hormonal balance, decreased immunity and bone health, cardiac abnormalities, and, ironically, slowed metabolic rate. This is why IF might be counterproductive, particularly if it leads to insufficient caloric intake. 

There is also research to support that even if total energy intake is adequate for the day if we have an intra-day energy deficit that is too great women can have metabolic disturbances. This research suggests that IF is the exact pattern to avoid to keep active women’s hormones more balanced.

When you’re training regularly, your body needs more fuel, not less. So if you pair the increased activity with fewer calories, there’s going to be a mismatch between the energy your body needs and what you’re providing it. As a result, your body could start limiting essential cognitive and physical processes to try and save energy, and you might down muscles to try and provide more fuel. This is one of the main reasons I don’t recommend IF for runners, cyclists, triathletes, and other athletes.

In addition to athletes being wary, IF is not recommended for anyone who’s pregnant, has type 1 diabetes, takes insulin or experiences hypoglycemia, or has a history of or current eating disorder. As emotional volatility is associated with a caloric deficit, IF might also be risky for some people with mental health challenges.

If you’re unsure about whether IF is right for you, please don’t hesitate to reach out for a consultation.

It’s all too easy to think, “I’m just going for a short run. I don’t need to fuel.” and skip eating beforehand. The problem with doing this is that even though the intensity or duration might not be high, your body still needs energy. If we don’t give our body fuel before a run, we dip into our glycogen stores & cause more stress on our body than needed. This could lead to a dip in speed, early onset fatigue, increased rate of perceived exertion (RPE), and other performance problems, according to a paper published in Medicine & Science in Sports & Exercise. 

To get ahead of these, make sure you’re eating at least a little food before you head out to train, with carbs being the basis for your pre-workout snack. Remember: you aren’t just fueling for the work immediately ahead but for the entire week of training. Need more guidance? Check out my recent blog post for in-depth info. 

Even if you fuel before each training session, you’ll also need to stay hydrated before, during, and after to truly support performance. Every process in your body suffers from dehydration, which can lead to cramping, headaches, poor performance, delayed recovery, GI issues, and many other symptoms. You may find it easier to stay hydrated when it’s hot or humid outside because the conditions make you feel more thirsty. But as I shared in a recent article, your thirst can drop by 40 percent in colder weather. So make sure you don’t always drink to thirst and put this hydration plan into action: 

• Start your day with 16 oz of fluid like water, coffee, tea, or a sports drink 
• Keep a water bottle full of fluid with you throughout the day
• Drink water with meals and snacks
• Take fluid with you on long runs over 70 minutes
• Rehydrate after runs and workouts

Beware of any diet that eliminates or limits certain macronutrients or claims that you should be scared of carbs, protein, or fat. Most people find that their bodies work optimally with a balance of all the fuel sources. Carbs are the main source of fuel for the body and brain, protein is vital for muscle building and repair, and fat is necessary for cellular health, combating inflammation, and hormone production.  

So try to include all three macronutrients at each mealtime and in your snacks. This should give the right balance of fast-acting and slow-burning fuels to power your best performances, keep your energy level high all day, and feel great. Including a wide range of colors at each meal will mean you’re also incorporating a variety of nutrient-dense fruit and vegetables into your daily diet, which helps ensure you’re getting enough vitamins and minerals.

You’ll be at your best when you’re consuming adequate calories to match your training, recovery, and everyday activity needs from the time you get up until you go to sleep. Sometimes clients don’t have an overall calorie deficit or insufficient macronutrient intake for the total day but still struggle with low energy availability surrounding runs, mood swings, and other physical, cognitive, and emotional issues because they’re digging too deep of an energy deficit around training. If this persists, they’re at risk of developing RED-S (relative energy deficiency in sport), which the International Olympic Committee states can disrupt 12 major body systems. 

A simple fix is to surround your training with solid nutrition. And, increase the frequency of your meals and snacks, so your energy intake is distributed evenly throughout the day. Take an honest look at when you’re eating and see if you can find any big gaps. Then plan meals ahead, set reminders to eat, and take snacks with you for those busy times so you don’t go too long without eating. This will help you stay out of large energy deficits, keep your energy levels consistent, and provide enough fuel for whatever comes your way. <<We’re a big fan of shower shakes around here.>>

One of the biggest misconceptions is that runners don’t need extra protein. Endurance activities such as running, swimming, cycling, and triathlon cause muscle damage from repetitive and prolonged movements that require protein to repair. Some studies have shown that endurance athletes underestimate their protein needs by over 20 percent and don’t get enough to kickstart their recovery process after exercise, making it harder to bounce back between sessions. Inadequate protein intake also hampers healing from injury. 

Aim to get at least 20 to 40 grams of complete protein (which contains all nine essential amino acids) at each meal, incorporate protein into your snacking strategy, and consume another 20 to 40 grams with some glycogen-replenishing carbs after every training session. You might need even more if you increase your training volume and as you age.

Most of the time when my clients aren’t fueling properly, it is due to underfueling, often unintentionally. And as I wrote in our recent RED-S series, it’s often difficult to accurately gauge your energy needs when you’re training hard, meaning that you might actually be underfueling even if you think you’re taking in too many calories. That being said, overfueling still happens – which means we are consuming more energy than our bodies need on a daily basis.

If you think you’re consuming too much fuel, there might be some reasons that you believe this. Maybe your body weight or composition isn’t what you want it to be or has recently changed, or maybe you’re struggling to return to what used to be your usual & preferred body composition. Remember there are other factors that impact our weight, like chronic stress, sleep deprivation, hormonal changes, chronically not eating enough, or not eating balanced meals, amongst other factors. 

At times there may be a mismatch between the energy you need and what you’re eating on a daily basis. If you are consuming more than your body needs for daily functioning, exercise & recovery, you might be overfueling. It can be hard to know if we are truly overfueling or not. We may be overfueling if we feel overly full after meals and snacks, excessively snack when we’re not hungry, eating to cope with feelings or other emotions, or over-restricting during the day and eating more than our body needs at night. 

As I’ve written about before, I see more athletes underfueling during runs, rides, swims, and lifting sessions than those who are on the other end of the spectrum. But I have seen a couple of athletes taking in more fuel than their body needed and experiencing negative consequences. This could be because you’ve had a bonking experience in the past, are anxious about getting in enough fuel, or have heard all the new research about fueling more and giving it a whirl without practicing it in training.

While fueling needs vary, I typically recommend getting your first gel down within 30 minutes and then consuming another every half hour. If you’re an elite competitor or a larger athlete, you might need more fuel than this, but taking too many gels may cause performance tanking issues like nausea, vomiting, stomach cramping, and discomfort. If you need help calculating your gel intake, take a look at my free online calculator, Customized Race Day Fuel & Hydration plan or reach out for a consultation.

One of the most common mistakes I see runners and other athletes making is focusing too much on the number of calories they’re burning during training. And focusing on ‘eating back’ all the calories ‘burned’ during a run.

One thing I see athletes do is have a “free for all” mentality on long run/workout days – thinking because they burned x amount of calories, they can eat whatever they want for the rest of the day. However, doing so can make you overshoot your fueling needs, leading to excess calorie intake. I’d rather see my runners focus on spreading out that energy intake pre-run and post-run so that they meet the demands of training and kickstart recovery afterward. Check out my piece on recovery nutrition for runners to see more detailed tips. 

Another way that athletes sometimes end up consuming more energy than they need is by grazing throughout the day instead of eating solid meals. Working from home, changes in appetite and busy schedules make grazing very easy. But if you’re constantly snacking, it’s easy to eat more than you need – energy-wise – yet miss the boat on the balance nutrition we get with a planned meal. One way to remedy this is to eat meals that are more filling and better balanced. These should typically contain plenty of protein and carbs. Don’t forget to include some fat, as this is the most calorie-dense macronutrient and will help you stay full for longer. Fiber is another nutrient that will help to keep you satiated between meals. You should feel like you’ve had enough after eating, without being uncomfortable. The same goes for snacks. 

• Eat 3 meals per day – balanced with carbs, protein, fat and color. Make sure you are eating enough protein at meals.

• Include fiber in your meals <except for pre-run meals> to help with satiety.

• Make sure you nail your recovery meal post-run/workout.

• Include snacks if your timing between meals is greater than 4 hours or if you are hungry in between meals.

• Stay hydrated.

• Reach out to a sports dietitian to evaluate your intake for your current training & help you gain confidence in your fueling plan.

• Looking to create new habits to improve your nutrition & body composition? The Off-Season Body Composition Program may be the perfect option for you.

Dealing with acute, short-term LEA can be frustrating enough, but if it continues for longer periods of time, you might start to notice more serious health issues developing and bigger drop-offs in your training and recovery. As with inadequate vitamin D and calcium intake, chronic LEA increases the risk of low bone mineral density and decreased bone strength, contributing to a higher incidence of stress fractures. If you’re already dealing with a bone injury, consuming inadequate calories and lack of solid nutrition can slow your healing process. RED-S might also elevate your chances of developing other overuse injuries.

In last week’s post, I shared that 30 kcal per kilogram of fat-free mass (FFM) or less was considered to be the danger zone for LEA. While this is a good clinical rule of thumb, some studies have shown that women who were above this threshold still had menstrual functions that were all over the map. Researchers from Penn State found that multiple kinds of disturbances – including luteal phase defect, anovulation, oligomenorrhea – can become more frequent when female athletes have persistent energy deficits. 

According to the International Olympic Committee, RED-S doesn’t merely compromise bone health and disturb the menstrual cycle. Persistent LEA can also cause a whole host of health issues and exacerbate existing ones in many other body systems. Some of the long-term effects include:

Endocrine

• Disrupted levels of estrogen and progesterone in women
• Low testosterone in men

Metabolic

• A 2015 study on the female athlete triad (the interrelationship between LEA, menstrual function, and bone mineral density) found 53 percent of LEA participants had a decreased resting metabolic rate (RMR). Others were struggling with low bone density, high cholesterol, and low blood sugar   
• Impaired ability to use glucose effectively and sometimes low blood glucose levels 

Hematological 

• Low ferritin and iron deficiency anemia 
• Iron deficiency can further decrease appetite

Cardiovascular 

• Higher lipids
• Cardiac abnormalities like lower or higher heart rate

Gastrointestinal 

• Delayed or faster gastric emptying
• Diarrhea and constipation

Immunological 

• Increased risk of illness
• Decreased immunity

Psychological 

• Depression and anxiety
• Mood disturbances 

Growth and Development

• Stunted growth in adolescents
• Decreased growth hormone release

When someone finds out they have RED-S, the logical conclusion is that they simply need to eat more. This can certainly be the case, as having an overall calorie deficit is a major part of the problem. However, a bit more nuance is usually needed to remedy the issue, which is where a dietitian can help. When I look at a client’s eating habits across an entire day, I often see that there are certain times when they aren’t taking in enough energy, leading to lopsided energy intake over a 24-hour period and an overall deficit. 

For example, perhaps your mornings are crazy because of your commute or school drop-off, so you often skip breakfast. Or maybe work gets so busy that you don’t eat lunch several days a week. So by the time you get to midafternoon, you’re already energy deficient. Then you go and run hard, digging an even deeper hole. Once you’ve had help to pinpoint specific fueling gaps, you can start to fill these so that you have enough energy for daily life and training. 

A qualified professional can confirm whether or not you have RED-S or are struggling with LEA, and then create a comprehensive plan to help you bounce back. In addition to identifying gaps in your eating schedule, they can suggest better choices for snacks and meals, recommend supplements if needed, and take into account the big picture of your training, recovery, and lifestyle to help you find a more sustainable energy balance. As I wrote in a previous post, it’s time to stop being scared of carbs and embrace a well-balanced approach to nutrition.  

Sometimes the solutions to low energy availability are simple ones, such as incorporating more calorie-dense foods. For example, you could start adding a couple of spoonfuls of nut or seed butter to your post-workout shower shake. Frequency is another easy variable to change, as adding morning and afternoon snacks will increase your energy intake. Some of my clients have also benefited from eating a pre-bedtime snack, like a Greek yogurt parfait with berries & granola. Others have started eating a second breakfast. Ultimately, you have to fuel like you hope to perform, live, and recover. 

Most people’s eating is primarily directed by their appetite, but remember that this is often a lagging indicator of needing energy and can be disrupted by your sleep pattern, exercise, caffeine, and other factors. You’ll be better off planning for your fueling needs like you would build out your training sessions. A good rule of thumb is to fit in at least three meals and two snacks each day, not going more than 3 hours without eating and focusing on balancing adequate carbs, protein & fat. While it’s important to get enough carbs and protein, they only contain four calories per gram, whereas fat has nine, making it an easy way to up your energy intake.   

Also make sure you surround your energy expenditure – whether that’s a formalized session like a run or gym workout, or family activities – with more nutrition. In other words, eat before, during (when needed), and after exercise, and recognize that more intensity and volume will increase your fueling needs, such as if you start strength training or doing some two-a-days. It’s easy to get discouraged if you have RED-S/LEA but know that you have the power to overcome this and that there are people out there with the passion and knowledge to help you recover. Some of my clients have reported starting to feel and perform better in a few days once they increase their energy availability. 

If after trying these tips you still can’t keep up with your energy needs, then try cutting back on your training temporarily. Then when your schedule and lifestyle allow, scale up your workouts and nutrition again simultaneously. 

If you’re struggling with LEA or RED-S and need help, please reach out. I’ve helped many clients to overcome this issue and would welcome the chance to get you back on the path to optimal performance and health.

Finding yourself in a calorie deficit occasionally probably isn’t going to be a problem, if you recognize it and make changes. But when you consistently have insufficient energy intake or the amount of energy you are expending is far greater than your intake, or both you might have low energy availability (LEA) which could lead to RED-S. According to a consensus statement by the International Olympic Committee, “LEA, which underpins the concept of RED-S, is a mismatch between an athlete’s energy intake (diet) and the energy expended in exercise, leaving inadequate energy to support the functions required by the body to maintain optimal health and performance.”

As a result of this mismatch between how much energy your body needs and how much you’re giving it, you can begin experiencing health issues, a performance drop-off, and inadequate recovery, as your body struggles to find ways to get the energy it needs for basic functions while also fueling your training and recovery. The IOC paper defined RED-S as “impaired physiological functioning caused by relative energy deficiency, and includes but is not limited to impairments of metabolic rate, menstrual function, bone health, immunity, protein synthesis, and cardiovascular health.”

One of the ways that registered dietitians and other practitioners try to identify whether someone is suffering from RED-S or a similar condition is by calculating their energy availability. Calculating food energy intake minus exercise energy expenditure equals energy availability. The leftover ‘energy availability’ must be enough energy for your body to fuel basic physiological processes.

For many athletes, they need to be consuming 45 kcal/kg FFM (fat-free mass) at baseline + recouping any energy needed for training. An energy availability of 30 kcal/kg FFM or below, is called ‘low energy availability.’ This means the amount of calories you’re consuming cannot support your daily energy needs plus the fuel your body requires during and after exercise. The deficit compromises body systems that need fuel, which start to shut down to preserve energy and keep you alive.

Calculating your exact FFM is difficult and not accessible to most people. FFM is measured or estimated by dietitians or medical professionals – so if you are concerned in this area, please reach out to your sports dietitian or physician.

There’s a reason that the S in RED-S stands for sport. Whether you’re a runner, cyclist, triathlete, or dabble in multiple disciplines, the more active you are, the greater number of calories you’ll burn. It isn’t just about your energy needs during training either. Your body needs extra fuel to support recovery and lean muscle mass is more metabolically demanding. Plus, there are many energy-dependent processes your body and brain need to perform to keep you functioning. Overlooking these factors is why some athletes drastically underestimate their fueling needs and can slip into chronic energy deficiency. Studies on runners suggest LEA (low energy availability) is most prevalent with high training loads, high energy expenditure, and low energy intake. A sudden increase in mileage and/or intensity, changing nutrition choices or restricting new foods, lack of hunger cues or decreased appetite with higher training loads, and competing in more races could all put an athlete at greater risk for RED-S if they are not conscious of proper fueling.

While chronic energy deficiency is more prevalent among women, male athletes can suffer from RED-S (see recent Ryan Hall post). Reasons can include societal pressure to look a certain way as a runner or endurance athlete, advice from a coach that leaner improves race times, lower caloric intake to begin with, disordered eating, lack of knowledge on how to fuel your body for your training load, and an energy deficit from pursuing a new dietary pattern and restricting foods or times of nutrition.

It’s a misconception that only people who are battling eating disorders struggle with RED-S. RED-S isn’t always paired with disordered eating, fear of consuming too many calories, or other unhealthy perspectives toward food. One of the most common causes I see among my clients is unintentional underfueling – that they simply underestimate the amount of fuel they need to power their performance and recovery, while also meeting their daily energy needs.

Sometimes, RED-S presents several warning signs that pop up like an engine light in your car. However, researchers from the University of North Carolina found that when observing male athletes with RED-S,  “participants displayed no major hormonal or bone health disturbances” in the short term. This means that it could be harder to pinpoint the condition in men than in women, who often start to experience changes in their period and/or stress fractures (more on the long-term effects of RED-S to come in part two). That being said, an article by Brown University stated that “This often unrecognized disorder can include low energy availability (inadequate caloric intake); with or without disordered eating; amenorrhea (lack of menstrual periods); and low bone mineral density.” In other words, RED-S can go undiagnosed in women too.

When red flags do appear, they typically impact performance and recovery first, and then begin to extend into overall physical, mental, and emotional wellbeing. Common symptoms of RED-S include:

• Poor performance (such as inability to hit or hold paces, quicker time to exhaustion, and increased perceived effort)
• Delayed recovery 
• Decreased power and strength output
• Chronic fatigue
• Feeling heavy, lethargic, and low on energy
• Loss of bodyweight and muscle mass
• Sleep disturbances
• Nagging injuries
• Disrupted menstrual cycle and/or missed period
• Emotional volatility and irritability 
• Change in appetite
• Delayed recovery
• Lower heart rate variability (HRV)

Check back soon for part two in this series, when we’ll explore what you can do to reverse RED-S (hint: it might be easier than you think, and you CAN come back from this!).