“It is a difficult thing,” Duncan says . “If you’re lighter, you’re going to run faster, but it is a very fine line and if you cross that line you’re going to run slower, and you’re going to get injured.”
In the RED
Relative energy deficiency in sport (REDs) is the consequence of a long-term mismatch between the dietary energy being provided and the energy demands from exercise. When there is not enough energy left over to fuel the body’s basic systems, it starts to break down, and both health and performance suffer.
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Just six months ago, the International Olympic Committee updated its statement on REDs. It wrote that detrimental outcomes include – but are not limited to – weakness, poor recovery, decreased power and endurance, decreases in energy metabolism, reproductive function, musculoskeletal health, immunity, glycogen synthesis and cardiovascular and haematological health, as well as impaired mental wellbeing, increased injury risk and decreased sports performance.
Given the condition was only recognised officially in 2014, researchers are still trying to get an accurate picture of its prevalence, but it’s estimated between 23 and 79.5 per cent of women and between 15 and 70 per cent of men are affected. One 2023 study found it affects recreational and elite athletes equally.
A problem of culture, education and comparison
Women tend to suffer from REDs the most for several reasons.
“Women have social pressures to look and act a certain way, especially around food and what they’re supposed to look like for their sport,” says exercise physiologist and nutrition scientist Dr Stacy Sims.
Women’s brain are also more sensitive to low calorie intake and need more fat mass for their endocrine system to function, so where fasted exercise might be OK in men, it can be damaging for a woman.
Women might see short-term gains as their body compensates for an energy deficit, but in the long term their body can’t recover as well. When people already have busy lives and are juggling children and work and training, they may attribute symptoms to sleep or stress.
“There’s not enough education around it,” says Sims. “If you’re low on glycogen from not recovering well enough, that feeds forward to your next workout … and so you have increased inflammation and this increased metabolic rate trying to repair everything, so it is cascading events.”
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Social media is also often bad influence: we compare ourselves with other bodies, adopt other people’s approaches, and are exposed to misinformation.
The impact of social media was a “big issue” in a new Australian study, which found over a third of pre-professional dancers were at risk of REDs and many had missed their periods for more than three months, or had irregular periods.
“It is a can of worms in terms of food advice, but also in terms of making them feel inadequate and wanting to lose weight,” says the study’s co-author, Associate Professor Sara Grafenauer, the program lead of Nutrition and Dietetics at UNSW.
Poor advice from coaches compounded the problem.
One participant had been told to only eat “light salads, and Cruskits with cottage cheese”, while another said she had been told not to eat lunch before class because the teacher could see it.
It’s not quite the 2019 scandal where young students of the Vienna Ballet were advised to smoke cigarettes if they felt hungry, but it can have equally disastrous consequences.
“My concern was that it’s the third-most popular physical activity for Australian girls,” says Grafenauer. “We need to move on from just skinny, weak dancers. And we know that longevity in careers is really very much better supported by better nutrition, strength training, and actually having some better advice.”
Elite athletes typically have access to a dietitian and knowledgeable guidance, says Professor Ben Desbrow, a fellow of Sports Dietitians Australia and head of performance nutrition at the GC Titans.
Ready: Melissa Duncan.Credit: Justin McManus
Still, he acknowledges: “There’s no doubt that in certain sports and environments, people’s views on how to produce the best athletes need to be challenged.”
The way an athlete looks is an overly simplistic thing to concentrate on in an attempt to change performance, he adds, and is a particular problem in certain activities, including long-distance running, cycling, dance, triathlons and swimming.
“But it’s widespread everywhere”, says Sims, a former professional cyclist who first became aware of REDs after noticing athletes on restricted eating plans were not lasting more than a season, and recreational athletes she spoke with whose bodies were also breaking down.
Fuelling better performance
People particularly at risk are those regularly doing 90 minutes or more of training and who are eating in a restricted manner. This might mean eating low-carb foods, not enough overall intake, not fuelling before and after sessions, or intermittent fasting (as opposed to time-restricted eating – starting and finishing earlier in the day – of which Sims is an advocate). Desbrow reminds it can present differently in different people.
Duncan has spent the last three years healing her body and mind from the ordeal. She has learnt that performing at your best doesn’t mean sacrificing your body, including your menstrual cycle. She has let go of the judgments others make of her body and comparing it. “Everyone’s got their own unique recipe,” she says. “Everyone’s body looks different and performs differently, and so you can’t compare yourself to other people.”
She has also focused on fuelling more, ensuring she eats before and after every session and giving herself time to recover properly. She never had much more than a banana and a coffee before early sessions in the past, whereas now she ensures she has carbohydrates such as overnight oats or crumpets before she runs, and a protein-rich meal afterwards.
“It’s just making sure that there’s plenty of fuel in the tank so that your body doesn’t have to go into its stores,” she says. “But also, I’ve just noticed it just helps me run so much better because you have energy. Literally.”
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