Megan Flanagan: A Young Runner’s Journey through RED-s (relative energy deficiency in sport)

Full Transcript

Cherie: Hello and welcome to Strides Forward, where each episode features one woman’s running story centering on one topic. I am Cherie Louise Turner, the host and creator of Strides Forward. This episode is part of our ongoing series about running in a woman’s body, where we’ve been focusing on the topics of menopause, pregnancy, and RED-s.

And in this episode, we’re focusing on that last topic, RED-s, or REDS, which stands for relative energy deficiency in sport. This is the syndrome that used to be called the female athlete triad,

If you aren’t familiar with the term RED-s or don’t really understand what this syndrome is, that’s a reason to stick around. Because this condition is avoidable if you understand what it is and how to avoid it.

And it is really common among women athletes, especially runners. 26-year-old Megan Flanigan was one of them.

And her athletic career began when she was very young.

Megan Flanigan: Yea, so growing up, I was involved in a number of sports, um, since, way back. I mean, I did gymnastics, I tried ballet, uh, was not into that. I did gymnastics, though, for about seven years. You know, I can remember seeing pictures in gymnastics, even of me shooting up before everyone else in terms of height. Me being close to five feet when I was, what fourth grade and feeling like a little bit awkward at the time, just to be so tall when I think gymnasts tended to be tinier in terms of their height. Um, so I was definitely conscious of that, like at an early age, I mean fourth grade or by 10 years old.

Cherie: Megan moved on to play basketball, a sport she thought would be more suited to her height advantage. And while she didn’t quite click with the team ball sports, she did notice that she was often the first one down the court, and that she liked being an athlete.

Megan: I loved those physical fitness tests in school. I remembered really priding myself on being physically fit. And I, you know, I think a lot of it was because it made me feel so powerful and strong and capable. Um, but there was kind of this weird sense even so early that I can recall this, like, these thoughts of how that made me feel, I guess, as an individual and maybe like my worth coming from, you know, being fit and being fast.

Cherie: Physical ability can cut both ways: it can make you feel confident and empowered, but it can also become central to how you value yourself.  So much so that, instead of moving from a place of empowerment, you begin operating in a place of fear. Fear of not being the fastest, the strongest.  And then there is the challenge of navigating the gauntlet of body commentary and body image.

Megan: I think there was just always this weird fear of like, um, gaining weight and not to an extent. I mean, I was again very small, like thin, uh, but I did shoot up again before everyone else in terms of height. So I felt really tall and gawky and lanky, but, um, anyway, I think that sort of manifested in middle school then finally getting into running and again, feeling like the biggest one on the starting line. And when I say big, I just generally mean tall and I was strong, but, and I had muscles for a runner, but I think that was just noticed by myself probably more than anyone else. Um, but you know, there’s always those comments of, Oh, like, could you do you run, you look like a 400 runner and I’m wondering like, why is that? That I don’t look like a, you know, long distance runner or, um, I look like a soccer player. I got that a lot. Uh, so I think just some of those comments that, you know, maybe when you’re thinking about how these issues with around body image and RED-S tend to begin, it’s like those early, early stages. So getting to maybe some of those inklings of how my whole journey with underfueling started.

Cherie: At its core, RED-s is precisely a journey of underfueling. It’s the combination of not getting the amount of nutrients your body needs to keep up with the amount of activity you’re doing. It’s the result of not getting enough of the right nourishment day after day, month after month, sometimes year after year. Sometimes that undernourishing looks alarming like a serious eating disorder, and sometimes it looks like the normalized behavior of a young woman restricting food. And this, at least in part, can be kicked off by what people are saying about her body, from a young age.

For Megan, messages about body image and shape didn’t just come from her athletic life; she was picking up on conversations away from sports as well, like what she remembers noticing from her mom.

Megan: I remember she was always in, I think it’s maybe generational, but she was always on some kind of diet or, um, you know, kind of commenting on other women’s bodies and appearances. And again, I think that was just her upbringing, but it really sunk into me that like, and not just from her, but I think from other women that like our value and worth depends on our ability to maintain a certain weight or to look a certain way. And she wanted me to be, to be a cheerleader when I was younger and that kind of sunk into me too, of like this whole sport and again, not to put down cheerleading, but it just wasn’t for me, and I felt like there was this big show about how you had to look. And so I just remember that feeling, that pressure and that sense of like, I have to stay this way and, just this inherent fear of like gaining weight and always thinking I was bigger.

Cherie: And while Megan heard women talking about other women among themselves, her own personal experience with having these comments aimed at her body, were from yet another source.

Megan: It came from men when it comes to comments on bodies. I can hardly recall a woman commenting on my body, but I remember distinctly in college having, you know, whether it was an athletic trainer calling me a nickname for muscular and kind of thinking, Oh, that’s cool. Like he notices I’m strong, but also like, Oh, there’s a pretty big difference between me and my teammates who, you know, don’t carry as much muscle. Um, and then also just random strangers that would comment on like, You sure don’t look like a cross country runner. I wouldn’t have guessed that by your quads or your thighs. And so I just remember these comments, especially around having muscular legs and even in high school, actually having some kid soccer player comment on my calves because I have muscular legs and, but, to me at the time I was so self conscious of like, Oh my gosh, he notices my monster calves. Or like, I think that’s what he referred to them as.

Cherie: This link between body size and performance coalesced in Megan’s teen years.

Megan: I’m in high school. Yeah. I’m running cross country. It’s funny. Cause I can remember looking at pictures now of like between sophomore and junior year and maybe putting on a little bit of weight from low like pasta dinners and just kind of having a really healthy, overall relationship to food, like just naturally puberty and all that hit and not really thinking anything of it, but somehow something kind of changed in me, and looking at the competition and who was winning these races and it wasn’t even among our team. We had a pretty healthy team culture back in high school and a supportive coach. I mean really, but I think it was just that looking from the outside at who’s winning, like Nike cross nationals and some of those huge meets and thinking I had to look like them or like, because I didn’t look like them, that’s why I wasn’t winning or I wasn’t doing well. And I always attributed it somehow to my size. And so that was always just something I was self conscious of, feeling like I was still large in comparison and had a long way to go.

Cherie: This self-consciousness and thinking her own body didn’t look like a body that wins races, led Megan down a predictable line of thinking.

Megan: I wish I could be smaller, I guess was kind of my thought, but like that’s just the way I’m built. And I guess I had to sort of come to terms with that too, of like, you know, I’m just not necessarily gonna mold my body into this way, but like at the same time kind of feeling like I was constantly fighting against my body, by being a distance runner, a lot of times I felt like I would have to just, uh, it was like an uphill battle almost to, to sort of maintain what I thought I should look like for a distance runner.

Cherie: And so the quiet but powerful conflict between what Megan believed she should be and who she saw in the mirror began.

Megan: I’ve worked with a number of professionals and never really had a diagnosed eating disorder. So this didn’t like go into full blown anorexia, bulimia, but it was definitely this, this, like self-consciousness of just constantly putting down my body and kind of trying to make it be something it wasn’t. And I think that was through just like under fueling and uh, yeah, I mean overexercise, but really I was just doing what my coach told us to do and at the time, you know, you’re just, you’re just training really hard. So I just wasn’t fueling to keep up with that.

Cherie: Soon enough, Megan began exhibiting one of the most common tell-tale signs of RED-s.

Megan: I inherently always knew there was something wrong with missing my period. I told some teammates when I first got into college and even probably late high school, I was like, do you guys ever miss a period? Is this just me? And you know, I almost felt in a weird way, like getting their responses of generally, no, actually from most of who I asked or people that just work, maybe they were, but they didn’t say anything, you know, where they said, Oh, I’m on birth control. So I don’t actually know. Right. So I was kind of like, well, gosh, this must just be my problem. It must just be me. But at the same time, that sort of fueled me to say, well, I’m bigger than all of these, you know, most of my counterparts and I still am missing my period this much, just be a sign that, I don’t even know at the time I just kind of went with it. Like that was sort of fuel of, well, you know, I don’t know, it was like a frustration of how can they be smaller than me and still be healthy quote unquote, or like having their cycles and inherently fine with everything else. And why is it me that has to, I just thought I had to struggle through this and like had to sacrifice my period had to restrict my carbohydrate intake or my calorie intake to sort of be this runner that I wanted to be, or that my coach wanted me to be. And I felt like I never really actually lived to my full potential in college because I was always battling, um, these kinds of struggles.

Cherie: Loss of menstruation is just one of several common symptoms of RED-s, and it points to a major disruption in hormones, which can cause all sorts of health problems. Also common is a loss of bone density, and many athletes with RED-s experience stress fractures because of this. But some don’t: the specific RED-s symptoms any one athlete experiences though are individual.

For Megan, in addition to losing her period, which is called amenorrhea, her underfueling led to chronically feelings of exhaustion, which were exacerbated by the demands of college life for a young adult. She was, by her own description, always on the go, but also always feeling like she just wasn’t thriving, like there was just something lacking. And, her search to find workable answers kept coming up empty.

Megan: Yeah. I mean, I was like inherently, there’s something wrong about this missing my period. I really need to find out why this happens and like how I can get it back. And I was determined to, but I would just get derailed and, and sorta defeated too, to be honest. I went to a doctor when I first got to college freshman year and I left crying. I mean, I never wanted to go back to a doctor because I’d had two doctors, both tell me and they’re female doctors, but they just didn’t have the knowledge or training. They told me I’d basically have to give up my running career. And this was freshman year of college. Like I just D1 athlete. Like I’m not going to give up my whole running career. So I remember walking out of there being like, I mean, they, they told me if I wanted, right. Like, Oh, if I wanted to restore my period, I’d have to give up running because that was just a part of being an athlete. They didn’t even ask about fueling or go into more detail.

Cherie: Megan was running for an NCAA D1, or Division 1, school. This is the highest level of competition for college sports. So she also had access to health professionals in her running life who were tasked with addressing issues that can arise for highly competitive athletes.

Megan: I remember athletic trainers also did diagnostic tests. Like they had to with all that and my bone mineral density came back fine. And so they kind of brushed it off like, Oh, you missed a period, but your bone mineral density is fine. And I would just kind of walk out of there, like, gosh, I guess I’m fine. You know, it just always seems so like, well, I guess this is just part of it.

Cherie: Megan surrendered to her circumstances. As she understood things, if she wanted to keep racing, she’d have to live without getting her period. But through surrender, she did not find peace.

Megan: Yeah, there was definitely a lot of like shame around it too. So I knew that it was a problem and it needed to be addressed, but I also, you know, within myself was still struggling at the time. So it was like this weird like secret of, well, I don’t really want anyone else to know or like, I’m just going to hide the fact that this is happening because I’ve already tried to open up to multiple people about it, like a good handful and they don’ t seem to care and they don’t seem to be worried. Um, so I just felt like nobody supports me and understands that this is a problem.

Cherie: There was no sign that the support Megan was looking for was ever going to materialize. And it was becoming ever more clear that her ideal of fitness and thinness and performance being inextricably intertwined was really problematic, and not just for her own wellbeing. She started to recognize this in other young women as well.

Megan: I think people can say, I want to look like so-and-so, but they don’t know what actually goes into that. And I now looking back had said those things a lot, like I want to look like her, right. I had no idea at the time that she was struggling. I think this is what started SRC too was I had no idea that this person was struggling, but I admired them. I thought I must look like her to be fast because she’s winning all these meets. And later down the line I find out she has a stress fracture and she’s not been eating, she’s anorexic, she’s in treatment. I mean all of these things, right. Mental health challenges. And so that’s where SRC really began was I thought there needs to be a platform for people to go on for women and girls to share these experiences and to know that they’re not alone and that this isn’t okay. Like we need to do something about it.

Cherie: With the help of a few teammates she confided in, Megan created SRC, Strong Runner Chicks, a community for women runners, where they could find and share support. She also changed schools halfway through her college career from Lamar in Texas, to the University of Minnesota Twin Cities, which was a school she really wanted to go to.

Even so, Megan’s own struggles with RED-s continued. Because this is a syndrome you can live with for years, while it slowly chips away at your well-being. The symptoms may be there, but they may not seem serious enough at any given moment to require immediate action. In many cases, it’s a slow drip, drip, drip, until the dam breaks. Until that time, however, many athletes, like Megan, just live with it.

In Megan’s case, during her college D1 career, she was fueling enough to get by and not raise any health alarms, but she continued to miss her periods. And while she was training and working hard, she just wasn’t thriving.

Megan: I never really felt like I hit my full potential in college. And I kind of was just a number on the team to be honest is what it felt like. So and, at Minnesota I would say too, our team educated or coach educated us. Um, so, you know, again had a pretty positive team culture and coach and the supportive and a dietician, a sports psychologist. But at the time just feeling like a number, a jersey kind of on the team, um, I, I just kind of continued to struggle, but also felt a little bit better because volume had dropped a little bit; mileage, I think just meant or kind of, um, yeah, I think I just, I did better on like a lower mileage program and, um, you know, we did a lot of strength training. We did a lot of injury preventative work. I was never injured. Thank God. I mean, I still have not been injured to this day and I do attribute strength to that. And again, I, I never skipped a meal like throughout this whole time, mind you. Like I haven’t, um, and I don’t say that out of defensiveness, but I think that was part of it is like, I really didn’t go these long periods without eating. But it was always carbs for me that were just, for some reason it was hard for me to get enough carbohydrates. I think it was instilled in me early on to like restrict those in some way. And so subconsciously I had to work so much against my mentality to restore my health through increasing carbohydrates. I mean, that was a huge one and overall energy balance, um, was another big one.

Cherie: While Megan continued to have her struggles with health and performance, she was also buoyed by team camaraderie and being a part of something bigger than herself, and because running was what she did, even after she graduated from university. There was that underlying sense of accomplishment that running brought to her life and there was always a race on the calendar to get ready for.

So she kept at it, until one day when she was faced with some stark evidence that her health was truly in crisis.

Megan: Getting a hormone levels checked and seeing I had like little to no testosterone, which women still need, you know, we still need some of that. And, uh, even female hormones, estrogen, progesterone, I mean, those just were so off the charts and they actually affected other things too.  I mean, I think, yeah, not to go into too much detail, but I nerd out on biomarkers and I think looking at mine and seeing how much red and yellow there was red and yellow lights, meaning like stop and pause. Um, I didn’t have a lot of green. And so I noticed like, Ooh, I’m not very healthy internally either because of all this and this could have long term consequences. So that was a big wake up call for me and a sign, and again, this was just done all on my own was like, yeah, I definitely need to take some action.

Cherie: Once she had graduated with her undergraduate degree, Megan did begin to refocus her attention on dealing with her amenorrhea, which led her to getting her blood tested and interpreting the data for herself. And these unquestionable test results snapped Megan to attention. This wasn’t something she could continue to put off any longer.

Megan: Yeah, so I’ll say I, I had lost, like I had very little energy and vitality, not just for training, but also for life. And I think that was reflected in my blood tests and panels looking and seeing all this red and yellow, in terms of falling short on certain nutrients, um, being iron deficient, I was very high on some cholesterol, which didn’t make sense to me cause I wasn’t intaking a lot of that. But after doing a lot of lit review research, I found that that was actually a side effect potentially of amenorrhea and um, noticing just, yeah, I, I think it was kind of just all in all things weren’t looking so hot. There was some sort of a, there was a sign of creatine kinase, which is muscle damage, which was way through the roof and red and I mean just the little to no testosterone.  I mean, you would’ve thought like, and again, I get it we’re women, but we do need some testosterone and I was so low. I just didn’t even know how it was like living and breathing without that. Like no wonder I didn’t have that energy and vitality, um, with some of these hormones that were just non-existent essentially. So yeah. I just didn’t want it to get any worse and I think sometimes fear can be a big wake up call for us. And that was kind of what I needed. That was like the last straw of, I need to do something or I’m definitely going to get injured or I’m going to have long-term consequences to my health.

Cherie: Megan started to come to terms with her health issues once and for all, and she began to give a hard look at what was really motivating her to keep running.

Megan: There was this question posed of, would you still be a runner, I don’t remember who originally said this, would you still be a runner if it didn’t make you look a certain way? And that really struck me because I think for so long, I had been sort of tying running to staying fit or being fit. And I don’t know that running has always been something that I would have done if I didn’t know it would make me look a certain way. Um, so I think that whole, like it’s so BS that running earns you food or anything like that, but I was definitely in some unhealthy traps there with thinking that I had to run to keep the body that I had, um, which is sad again to think about, but yeah. Um, but that question really got to me and I was like, yeah, I mean, I would still run, but maybe it would look different than it does now. Like maybe I wouldn’t push myself to this limit. Maybe I would just run for fun.

Cherie: Maybe I would just run for fun. In hand with adjusting her attitude about why she was running, Megan also took note of the relationship she’d been creating with her body.

Megan: I felt like for so long I was fighting against my body. I was constantly getting it up early at, you know, 5:00, 6:00 AM to go for these just runs I didn’t want to go for and doing these things I didn’t want to do. And it just seemed like I was constantly pushed to the brink of exhaustion. And I think I got out of touch with my body and sort of lost trust in it in a way.

Cherie: This process of building back that trust, of developing the ability to listen and adjust to her body’s needs has taken time. Similarly, it’s taken some adjusting to recalibrate her outlook on body image, which has been helped along by her own journey into becoming a coach and personal trainer.

Megan: It’s definitely been an adjustment to get used to the fact that, um, I don’t look the same way that I did, you know, a few years ago when I had RED-s. So I think that’s been tough, um, in a lot of ways and even thinking like, we’re not supposed to look the same way we did in high school. Right. Like when we’re 25 or 30. And so like, yeah. I mean, I just, but I thought for so long, I had to be my high school self, and I really, I mean, it’s sad, but I was like basically my high school size, um, through college. And so I think I just was fighting against reality and sort of like where my body’s happiest. I think I had to put the term health above all else, really at the forefront and health as sort of a foundation for performance. And so that’s just the mentality now of what I, what I go through. And also I think now being a coach, like what I want other athletes to adopt as this like healthy relationship I don’t want anyone to go through what I did.

Cherie: Megan wants to lead by example and she is also much more in tune with the detrimental effects of putting demands on her body that it can’t keep up with. So she continues to take steps to reset and heal in ways that work best for her.

Megan: I didn’t have any sort of agenda. I could kind of just go out the door if I wanted to and, you know, kind of listen to my body, but also know that, Hey, sitting on the couch and eating bon bons is not going to make me feel great about myself, even if it’s for a good reason. It, you know, it just would have been too mentally hard, I think, to give up the friendships I had through running too. And so wanting to continue to show up and be able to enjoy running for what it is and knowing that it, it just didn’t need to be for any sort of performance or agenda item, but just like going out for these easy jogs and, and hikes and just restorative activity that wasn’t demanding, but it’s still, I think that helped me versus like the whole stop cold turkey just don’t do anything and, that just was not working for me. So I had to kind of almost disguise it, like, you know, in a way that I, I still knew I was moving towards the goodness or, you know, moving towards better health and restored health. But I also felt like I still was moving in some way or still had like some semblance of, of running in my life. So that was important to me too.

Cherie: As Megan has let go of agendas and performance goals, she’s started to look forward to what fuels her athletic interests in empowering, sustainable ways, and most recently, she set her sights on a 50 mile trail race.

Megan:  You know, I’m kind of just embracing, just this whole, like, enjoying the process and planning these long adventures with friends in the forest and mountains and, and not really having like a certain time goal. It’s funny when people ask me like, well, yeah, what are you hoping to finish the 50? And I’m like, I don’t know. I just want to go out there and have fun. And I mean, fun in quotation, but type two fun. I just, I want to test my limits. I want to challenge myself, but at the end of the day, like I want to have a good time and, and, um, you know, treat my body well while I’m doing it. So for now, I’m just really kind of enjoying that process. And, and at the end of the day, that’s what matters. And I think races sure will return and be a part of my life, but it’s not going to be something I define my worth on or something I have to sign up for every weekend.

Cherie: Megan continues to forge a healthier relationship with running and through it all, is discovering new reasons why she wants to keep lacing up.

Megan: I think kind of the joy in running for me comes through just, um, appreciating what my body’s capable of and the opportunity to be out in nature. I’m often, you know, out in the trails and yeah, whether it’s alone and I’m getting some solitude or, and maybe time for reflection or it’s being with others and company. I, yeah. I think our bodies carry us so far and are just appreciating them has, has been something that yeah. Reminds me of the joy of running

Cherie:  And of course it isn’t only the pursuit of her own running that keeps Megan engaged; it’s also very much about the people she shares it with.

Megan: Community and connection has really been valuable to me in every facet of life and especially through running, so yeah, especially. And, I’m really passionate about bringing women together, empowering women, helping them to believe in themselves. And, I love to create those connections too, among women and women uplifting other women and not just seeing them as competition, but knowing that they’re out there to support and uplift and collaborate and I think that’s just been one of the most rewarding parts of starting Strong Runner Chicks has been seeing some of those connections that form.

Cherie: These days, Megan continues to help others through her work as a personal trainer and coach, as well as through her work overseeing Strong Runner Chicks, which she does to this day. And she continues to lead by example.

Megan: I think I’m in, you know, a much better place, in a place where I am restoring my health and kind of taking that step back. I think I’m ready to get back into competition and kind of, just with like a refreshed mindset and a sort of new outlook on what that looks like for me. So yeah, I would say overall kind of in a, in a good place in a place of wanting to move forward and, and see what’s next, but also knowing that there’s so much more beyond my performance that I’m excited about. And, and that’s kind of where the magic lies, too.

Cherie: A big thank you to Megan Flanigan for sharing her RED-s journey. We recognize that these stories are often challenging to talk about. We also recognize that the more women who speak out about their experiences, the more it will help highlight how pervasive RED-s is as well as help other women not fall into the RED-s trap. This is a condition caused by many small choices made over time. By educating athletes about ways to make healthier choices, we can help our sister athletes avoid or recover from this devastating condition.

We are grateful to Megan for being a part of that empowerment. And, I will add, Megan did do that 50 mile trail race and she had a fantastic time. You can learn more about that and what else Megan is up to on her Instagram feed, which we will link to in the show notes.

I’ll also include links to Strong Runner Chicks. And of course we’ll also link to where you can learn more about Strides Forward and where you can find us on social media.

As always, I’m very thankful to you for listening. We love making these stories, but they are  made to be heard, so you being here is critical. If you like what you hear, please share and spread the word. Strides Forward exists to highlight stories about women athletes. Only 4% of mainstream media coverage is dedicated to women despite the fact that 44% of sports participants are women. We know that stories are powerful and representation matters. Your support of shows like ours and the growing number of other niche outlets covering women athletes makes a difference.

The Strides Forward team includes me, Cherie Turner, your host and producer. Cormac O’Regan creates and places all of the music you hear. And he does it from his studio in Cork, Ireland. April Marriner of Bonfire Collaborative does all of the design work for the show, including the website, merch, and logo. She comes to you from Truckee, California. You can find April at bonfirecollaborative.com.

Strides Forward will be back in a couple of weeks with a whole new series. We’re pausing for the moment on these stories about bodies and are going to focus on the experiences of eight women from around the world as they prepare for the historic 125th running of the Boston Marathon, which is being held in October. Please join us! Until then, this is Cherie wishing you many healthy, joyful strides forward.