I Thought I Was In My *Sourdough Era* But I Got Diagnosed With RED-S Instead
The sneaky, long-term effects of eating disorders and calorie restriction can follow you way into your "recovery" years
⚠️ Trigger warning: Disordered eating
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Three weeks ago I would have told you that, after six years in eating disorder recovery, I was finally in my *sourdough era.*
I love salted butter, and I measure with the heart, not the tablespoon. I do not own a scale. I donated all the clothes that made me feel bad and I don’t exercise to punish myself.
I don’t even read nutrition labels anymore.
That’s why I was shocked when, two months ago, I was diagnosed with RED-S, a condition that primarily affects active adult women.
If, like me, you have a history of disordered eating or calorie restriction — even if you consider yourself “in recovery” or “healthy” — you should know that calorie deficit be causing major issues without your knowledge.
The female athlete triad: RED-S
RED-S — relative energy deficiency in sport — is caused by chronic low energy availability, or not eating enough to sufficiently meet your energy needs. Basically, your body’s “gas tank” ran on empty for too often and for too long, and it started to use your muscles and bones to fuel your activity.
Symptoms of RED-S include:
fatigue, feeling overtired
low mood, depression
irritability
changes in reproductive function and lowered sex drive
GI upset
irregular or absent menstrual cycles
RED-S used to be called the “female athlete triad” because it explained so many seemingly-healthy young women with injuries. My RED-S peaked when I was training for a half-marathon and couldn’t seem to overcome chronic hip pain I’ve had for sixteen years. My doctor was not surprised to learn that my eating disorder arose about the same time.
Athletic symptoms of RED-S:
not seeing progress in training
unable to maintain or increase lean muscle mass
recurring injuries or injuries that do not heal
Like with a lot of diagnoses, in retrospect, it seems really, painfully obvious: You have to fuel your body adequately or it will start to break down.
But when you’re not good at “listening your body,” you’ve restricted calories so long you don’t know any other way, or you’re struggling with your mental health, it’s easy to overlook your nutritional needs, and a serious condition like RED-S can fly under the radar.
But when you’re not good at “listening your body,” you’ve restricted calories so long you don’t know any other way, or you’re struggling with your mental health, it’s easy to overlook your nutritional needs, and a serious condition like RED-S can fly under the radar.
I’m at the point now where I’ve lived longer with an eating disorder than without. And while my anorexia and bulimia are under better control now than ever, the impact of long-ago calorie restriction is playing out right now.
I couldn’t finish a lot of the long runs while I was training for the half-marathon, and, during the race, I took half an oxycodone at mile five to get me past the hip pain. I spent the next day in the emergency room with colitis and rhabdomyolisis, and an MRI showed I have bone stress and micro-fractures in my hips.
Why?
The dietitian put it more gently than this, but, basically, I don’t know how to feed myself.
My Fitness Pal
At the height of my eating disorder I was purging, restricting, and over-exercising. I won’t go into the details here because it’s potentially triggering and irresponsible to post it on the internet. But I was also compulsively tracking it all on a godforsaken app called My Fitness Pal.
MFP is probably helpful for some folks. I don’t know. But I abused the hell out of it. It was an instrument of my own torture; I counted and logged every calorie I ate, and forced myself to exercise away every one of them.
This is dumb. Do not do this. As I am learning, my caloric needs are much higher than I thought, and the more active I was the more my body used the calcium from my bones to fuel itself. Going through surgical menopause last year probably didn’t help, and RED-S and calorie restriction can really mess with your metabolism.
I’m on a waitlist for a bone scan, but in the meantime I’m seeing multiple medical providers every week to try to repair the damage.
Heroin chic
I’m a child of the heroin-chic generation that pretended to be concerned about a rapidly shrinking Mary Kate Olsen and worshipped Keira Knightley’s collarbones. Thin was in.
I also thought this was tres chic:
Millennials came of age with a very, very thin beauty standard. Thus, I stole my mother’s Shape magazines and read them in class, because their covers touted ab-toning and weight-loss methods.
At that time, I was grappling with an unstable family dynamic, severe untreated anxiety, and an emotionally abusive relationship. I thought becoming a Victoria’s Secret Angel would solve all my problems (and make my boyfriend like me), and I quickly found that, next to running, starving myself gave me a semblance of control and numbed me enough to take the edge off.
But, in the context of a culture that promoted thinness and dieting, eating a handful of almonds and exercising to the extreme seemed totally normal.
I found a really great therapist in college who started helping me manage my anxiety. She was the first person to whom I admitted I had an eating disorder, and got me into outpatient treatment, but I stopped going when they tried to get me to inpatient treatment because I was afraid it would show up on my parents’ insurance.
It wasn’t until I met my husband that I was even willing to do something about my ED. I got on anxiety medication for the first time, and started ED therapy. I stopped purging and, by the time I got pregnant with my son, I considered myself reformed.
But, last month, when my healthcare provider asked me how many of my thoughts throughout the day were about food and my body, I had to answer honestly: Probably 60%.
That’s fucking sad, yo. And it doesn’t sound very “in recovery,” does it?
It’s no wonder I had RED-S. I don’t know how to adequately fuel myself to get through the day, let alone to run 12 miles and lift weights.
Treatment
The first, hard step of this treatment is to admit that I have a problem.
Well — actually — lots of problems. But food is one of them.
Even when you look like you’ve got it all under control on the outside, even when you’re a mom who condemns diet culture and bakes sourdough and gets ice cream with your kid on Fridays, you can still be in the clutches of your ED.
Luckily for me, after being diagnosed with PMDD and having a hysterectomy, I vowed to be kinder to my body and stop viewing it as a wretched meat bag that just got me from place to place. So when I met the dietitian I was ready to address all the shit I’ve done to my body, to make amends, and really heal.
Even when you look like you’ve got it all under control on the outside, even when you’re a mom who condemns diet culture and bakes sourdough and gets ice cream with your kid on Fridays, you can still be in the clutches of your ED.
I’m in my *sourdough era* and my era of asking for — and accepting — help. I hope you are, too. Not just because life without really good, crusty bread probably isn’t worth living, but because, if you’re also guilty of depriving your body, you may not outrun the consequences.
I took the last 13 weeks off from running and hiking, which has been terribly icky, but got me out of active RED-S. I thought that learning to feed myself appropriately would be so hard, but we’re taking it slow, and it’s going really well. With my dietitian I’m working on a nutrition plan which involves lots of fun snacks, and I can tell that when I fuel myself I get through the day without those afternoon and nighttime energy slumps (who knew??).
Hormones, mental illness, and chronic illness are intertwined, especially when there’s trauma in the mix. For me, addressing food is a big part of untangling it all.
If the same is true for you, especially if you have the symptoms listed above, talk to your healthcare provider before you sign up for a triathlon or a marathon, k?
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Thank you for this piece , I loved it. I have found the POST menopausal weight gain to be the most difficult because all those cute little restricting tricks I’d done for years stopped working !
I am very slowly trying to figure all of this out (with a nutritionist) and it’s really hard. I am never again going to be at that magic number on the scale. I have blocked out what it took to maintain that number and instead just feel bad about my weight. There is a huge amount of shame . But what helps me is thinking about how I want to spend the last chapter of my life - do I want to embrace my creativity, my curiosity , my hard won female wisdom ? Or do I want to be scared to eat a fucking sandwich ?
My Fitness Pal has a lot to answer for. I even went one better and used Lose It! So bad for those of us in ED recovery.