Signs to Stop Enduring: Ali Brauer's Experience with Relative Energy Deficiency in Sport (REDs)

Signs to Stop Enduring: Ali Brauer's Experience with Relative Energy Deficiency in Sport (REDs)

There are many less-than-glamorous aspects in the sport of triathlon. Peeing into a chamois pad, the volatile snot rockets that don’t make it over your shoulder, the chronic chlorine stench, funky toenails, oozing blisters… These are the things triathletes constantly encounter yet rarely speak up about because it’s simply part of the sport; enduring discomfort is part of the sport.

But how much discomfort is too much? Where is the line drawn between drive and destruction? Last February, author Kristen Seymour with Triathlete Magazine published a phenomenally informative article discussing Ali Brauer’s experience as a professional triathlete who met an all-too-common fate via overtraining, even when she was doing everything right. 

“Often, we hear about RED-S and overtraining syndrome (OTS) in the context of disordered eating, or athletes who didn't listen to their coaches and went overboard. But this is not my story”. 

I had the opportunity to interview Ali, who is also a former TTL Devo athlete, and delve further into her experience that forced her into a long term training hiatus.

Interview with Ali Brauer

After months in an elite training environment and degrading physical and mental health, you describe “The realization that something wasn’t quite right” as “very gradual”. What were some of the subtle warning signs that slowly emerged? Did you have a ‘gut-feeling’ that this was a deeper issue than being a little burnt out? If so, was it difficult to have your intuition contradict the ‘no pain no gain’ mentality of elite training?

The first warning sign of Relative Energy Deficiency in Sport (REDs) was way back in 2018 during my first year as a pro, just after I joined my elite training environment. I skipped my period for the first time in my adult life and had amenorrhea for several months. Notably, I was unable to recover from amenorrhea naturally because my training load was too high; instead, my cycle was “induced” by a single course of synthetic progesterone. After this, I suffered three metatarsal stress fractures in less than 2 years, most recently at the beginning of 2021.

Then, in mid 2021, I experienced a subtle but common warning sign of REDs: declining mental health. For the first time in my athletic career, I began to dread almost all training sessions - particularly team sessions - and struggled to find enjoyment in racing as well, though I actually achieved my best-ever triathlon results around this time.

A few months after my mental health went downhill, I started experiencing more obvious, physical symptoms of REDs: unintentional weight gain, extreme fatigue, extreme hunger (specifically, waking up hungry in the middle of the night multiple times per week despite intentional fueling during the day), insomnia, brain fog, GI issues, and unusually painful periods. For a while I was still able to tick off training sessions and hit good numbers, but outside of training, I had zero energy and was essentially bedridden.

Initially, it was easy to write off what should have been clear symptoms of REDs because 1) there was a lag time before my training and racing performance really began to suffer and 2) I’ve experienced mental health issues in the past. But eventually, I did develop a gut feeling that this situation went far beyond just my mental health, and beyond burnout. Specifically, when my physical health worsened, I began to suspect that overtraining might be part of the problem. However, due to unhealthy power dynamics in my training environment, it was extremely difficult to trust my intuition. So for a while I ignored my gut feeling and kept trying to grind through.

Eventually I could no longer ignore the signals from my body and mind that something was off, and I made an abrupt decision to move home in May 2022. It was only after making this change that I recognized the true extent of the situation. I finally got blood work done and based on my hormone results (TSH, cortisol, estradiol) - as well as my injury history and other symptoms listed above - it became evident that I had REDs. Finally, I began to recognize how multiple years of improper training and chronic mental stress in my former training environment had contributed to the development of this syndrome.

One of the biggest lessons I took away from this experience is that it’s extremely important to listen to your gut. At the end of the day, you know yourself and your body best. If you feel deeply that something is off, there’s a good chance it is.

Injuries are more than a physical ache or impairment. They are issues that demand a reaction in order to resolve. These reactions (recovery, time off, seeking treatment) can stimulate an immense amount of mental distress. Triathlon is a lifestyle. When injuries arise, they can topple a triathlete’s day to day routines / lifestyles, accumulating even more stress. How did/have you mitigated that stress? Do you wish you had done anything differently? 

It sounds cliche, but I’ve always found it very helpful to focus on what I *can* do. As triathletes, we’re fortunate that we can often work on at least one of our three sports while injured (depending on the type and severity of injury, of course) - or if that’s not possible, we can focus on physical therapy and strength work. Personally, most of my injuries were running-related, so I was generally able to focus on the swim and bike, and made huge gains there while I was recovering from my metatarsal stress fractures. Seeing this tangible progress definitely helped mitigate injury-related stress.

But you can easily take this too far. One of my biggest regrets is doing higher than usual swim and bike volume while I couldn’t run - especially knowing what I know now, that I was dealing with REDs for a long time before I became aware of it. Injury by itself is one thing, but injury in the context of REDs is a whole different ball game. REDs stems from a chronic energy deficit, so if too much of your energy is going into training, you’re never going to dig yourself out of that hole - you’re just perpetuating the problem. Looking back, it’s apparent that my training load was consistently too high, so my body didn’t have enough energy to fully heal until I took a massive step back from triathlon in late 2022.

Additionally, I think it’s difficult (perhaps even impossible?) to fully recover from REDs when your training is centered around performance, as mine was before I moved home - typically even when I wasn’t healthy. In hindsight, I wish I would have made a change sooner, so that I could have fully focused on recovery in an environment where health is the number one priority. I also wish I would have made it a priority to nurture other (non-triathlon-related) aspects of my life that bring me joy, which I’m sure would have helped offload some stress.

The sport of Triathlon requires significant mental training. We train our minds to endure, to become calloused and immune to discomfort. When faced with injury, this mindset can aid in self destructive patterns such as ‘just pushing through it’. How did you escape, pivot, or detach from this mindset? 

This is a really great question and something I’ve reflected on a lot in my recovery journey.

Honestly, earlier in life, I was never the athlete who pushed through everything. As a collegiate athlete (I competed in swimming, track, and cross-country at Lewis & Clark College), and then later on as an age group triathlete, I was naturally very good at self-regulation. I skipped team practices if I thought that’s what was best for me mentally and/or physically. I’m sure my coaches sometimes wished I was doing more, but I didn’t receive any pushback from them.

That all changed as an elite triathlete, as my former training environment brought out all my people pleasing and Type A tendencies - and not in a good way. Pretty soon I became the athlete who pushed through everything. I was praised not only for my grit but for my adherence to the training plan, which just reinforced these unhealthy behaviors. It was a survival mechanism more than anything, as there were a lot of things I pushed through not because I wanted to, but because I was afraid that there would be consequences if I didn’t.

Ultimately, I broke out of this pattern when I moved home and processed my experiences in this environment. I could finally see the power dynamics that had influenced my behavior and enabled unhealthy tendencies. Despite that, it was hard to break out of the “just push through it” mindset for a while, because I had developed this belief that I wouldn’t succeed if I didn’t hit a certain training volume and that I wasn’t “committed” if I took a step back. But at a certain point, my REDs symptoms made the decision for me. I had already pushed through so much that I was jeopardizing my health, my relationship with sport, and my athletic career. And I could see clearly that if I wanted to regain full health and any ability to train (not just at an elite level, but recreationally), I needed to stop what I was doing and take a major step back.

I also really love Steve Magness’ definition of real toughness vs fake toughness. A lot of athletes believe that being tough means pushing through everything, but according to Steve, that’s actually fake toughness. Real toughness is “creating space to take thoughtful action” when experiencing stressors. In the context of sport, this means slowing down enough to consider your emotions and make a decision that’s in line with what really matters: your long-term health and well-being. I realized that I’d been engaging in a lot of fake toughness throughout my elite triathlon career, but in order to recover from REDs, I HAD to choose real toughness.

There are many ways to engage in a triathlon lifestyle, but if I were to boil it down to two approaches I’d say a triathlon life is a balance of chasing numbers (rankings, stats, PR, the VO2 max, etc) and chasing waterfalls (the view, the vibes, the experiences). Understandably, pros often have to focus more on chasing the numbers, but at what point does this relentless pursuit of metrics overshadow the enjoyment and fulfillment derived from the triathlon lifestyle? How can athletes strike a balance between striving for excellence and preserving their physical and mental well-being amidst the demands of elite competition or personal goals?

I think the answer here is that it’s different for everyone. Some athletes get a massive sense of fulfillment from the more mundane side of the sport - hitting numbers, ticking off highly structured workouts, etc. Others need less structure and more “vibes” to find fulfillment. Personally, I’m somewhere in the middle.

As a newbie elite, I believed that a monk-like lifestyle and an “all-in” mindset were necessary to succeed at the highest level of the sport. But I’ve since learned that this couldn’t be further from the truth. Training won’t always be fun, but enjoyment can and should be prioritized. It’s okay to do sessions “just for fun” - not every session needs to have a purpose related to racing - and you should have sessions that remind you why you’re doing the sport in the first place. I also don’t believe that anyone should be “all-in” all the time. It’s important to have an identity outside of sport, and I think your brain needs occasional breaks from that intense laser focus or you’ll just burn out.

In my opinion, knowing when to “flip the switch” (i.e. when to turn off the hyper-competitive, performance-above-all-else mindset) is key to preserving mental and physical health. I think this is difficult for triathletes in general because the majority of us are Type A individuals, but it’s even more difficult if you’re in an elite training environment or any other cutthroat, high-pressure group environment - or even comparing yourself to other athletes on Strava, which I know is a struggle for many. You might feel like you need to compete all the time (even during easy sessions), complete training at all costs, etc., which is obviously not healthy. It’s crucial to listen to your body + mind and know when to drop the ego, forget about metrics, and just go out and have fun.

Moral of the story: try to occasionally check out from the hyper-competitive side of the sport, and figure out what sort of triathlon lifestyle works best for you. Everyone operates differently and needs a different mix of structure and “just for fun” training. Importantly, there is no one way to achieve success at the highest level.

As your health began to degrade and these numbers receded beyond your reach, you note how you  “[were] jealous of anyone who looked like they were having fun with training”. Could you elaborate on the emotional/mental shifts that led to this state of mind? 

This state of mind ultimately resulted from being in a training environment where I was pushed to go “all-in” and had very little autonomy. I became anal about following my training plan and essentially moved through life with blinders on, with a one-track focus on triathlon performance at all times. Eventually, I found myself in a place where training was devoid of enjoyment, where I often wished I could do something different, but felt like I had to ask permission to make modifications or do any activity that might take away from my goal of succeeding at the highest level of the sport.

I desperately wanted to re-find that fun factor, but as explained above, I felt completely constrained by my environment. Thus, I became jealous of anyone who looked like they were enjoying the sport. In fact, I had to stop watching TTL videos for a while because they were giving me massive FOMO and making me homesick (I’m an Oregon native). That should have been a major red flag!

This was a huge learning experience, so in my REDs recovery journey, I’ve put structured training on the backburner (as has been necessary for my physical health as well) and have instead focused on rediscovering joy in sport. A major part of this has been exploring new activities that would not have fit into my training plan before: cross-country skiing, snowshoeing, gravel riding, and mountain biking. These are also activities that have reminded me why I do sport in the first place. As an Oregonian, I have an incredibly deep appreciation for nature, and I feel most at home on tree-lined trails and in the mountains. All of the aforementioned activities allow me to connect with nature and fill my soul in a way that I never experienced when I had blinders on and was 100% performance focused at all times.

Now, it’s clear how desperately I needed a period of time where I could have full autonomy over my training, where I could be fully focused on doing what feels good and what brings me joy. My journey is still ongoing, and I’m still months away from re-starting structured training or even thinking seriously about racing - but without this recovery and exploration period, honestly, I’m not sure I’d ever compete again. I don’t know exactly what the future holds for me, but I do know that this step back saved my health, my athletic career, and my love for sport.

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