Warning: this article contains discussion of eating disorders
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"If you keep this up, you'll be in a wheelchair at 30.
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you → keep → 30
That is what doctors told British long-distance runner Jake Smith four years ago.
From the outside looking in, his career was flying.
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career → tell → outside
By the age of 23, he had signed a professional contract with Nike and represented Great Britain on the global stage.
But at the same time, his body was deteriorating - enduring a relentless pattern of race, illness, injury, repeat.
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body → sign → repeat
Balancing an intense training regime with disordered eating meant the 28-year-old returned from a running camp in Uganda weighing just eight stone (51kg) at 5ft 5in (1.7m).
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old → balance → ft
He had such brittle bones that he was told his career could be over.
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career → have → bones
After suffering two stress fractures in the space of four months, Smith sought professional help and was diagnosed with REDs – relative energy deficiency in sport.
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Smith → suffer → sport
It is a syndrome that can affect anyone and if left undiagnosed or untreated, can have an impact on performance and cause serious, long-lasting health problems.
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that → affect → problems
The symptoms are slightly better documented in women - just last month, tennis player Emma Navarro revealed her diagnosis and subsequent decision to step away from competition until 2027.
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Navarro → document → 2027
But men are just as susceptible and due to stigma and lack of obvious warning signs, it can go undetected for longer and means many, like Smith, suffer in silence.
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many → go → silence
BBC Sport explains what the condition is, how it affects men and women and why, despite its prevalence and severity, REDs remains a relatively under-reported and overlooked area of sports science.
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REDs can cause bone stress injuries, disrupted sleep, fatigue and low mood.
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REDs → cause → injuries
Left untreated, the condition can lead to serious long-term health problems, including osteoporosis, cardiovascular disease and fertility issues.
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condition → leave → osteoporosis
Dr Nicky Keay, an expert in hormone health, says many of these symptoms stem from hormonal disruption caused by insufficient energy intake.
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many → say → intake
"Hormones go to every single bit in your body.
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So, if your hormones are not working well for you, you're going to feel it in all sorts of different areas," she says.
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"In order to have healthy hormones, they need to be fed regularly.
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If you're not doing that and there's an energy deficit, often some of those hormone systems will slow down or shut down completely.
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some → do → systems
Women have a monthly barometer of their hormone health with the menstrual cycle, described by Keay as a "free monthly medical check".
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Women → have → check
Put simply, she says, a woman suffering from REDs has her periods "switched off".
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periods → Put → REDs
For men, it is more subtle – testosterone levels will drop, resulting in a reduced libido and fatigue.
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levels → drop → libido
The impact on a woman's period is why the condition was first referred to in the early 1990s as the "female athlete triad".
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condition → refer → triad
But it was renamed by the International Olympic Committee in 2014 to acknowledge the broader range of symptoms of energy deficiency and that it also harms male athletes.
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it → rename → athletes
"We realised we were ignoring the other half of the population," Keay says.
"
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It's a strange situation because normally it's women's health that is the one being ignored but, in this situation, it's the men who weren't being recognised or represented."
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who → ignore → situation
Twelve years later that decision appears to be vindicated, with recent research highlighting the prevalence in men.
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research → appear → men
Meta-analysis published in Australian journal Sports Medicine last year, following a study involving thousands of elite and amateur athletes around the world, indicated 44.2% of female athletes and 49.4% of male athletes had low energy availability.
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% → publish → availability
One of the answers lies in the phrase 'lighter is faster'.
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lighter → lie → phrase
For decades, it had been an accepted wisdom in sports like endurance running, cycling, climbing, horse riding, dancing and aesthetic sports like diving and gymnastics.
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it → accept → diving
And for athletes like Smith, it is how his problems started.
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problems → start → Smith
"I believed it for years.
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I thought that was the way forward," he says.
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he → think → ?
"I started thinking 'how do I improve my half marathon by 10 seconds?
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I → think → seconds
And that's when my head completely went."
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head → go → ?
Initially, the strategy can work.
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strategy → work → ?
When it comes to choosing energy to cover training demand or energy to stay healthy, the body has learned through evolution and threat of predators to always prioritise movement.
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body → come → movement
It means that athletes can drop weight and still train and exercise and achieve good results.
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athletes → mean → results
But eventually, the luck runs out.
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luck → run → ?
Described by Keay as "fool's gold", the body will adjust to the energy deficit and cause a drop in performance and high risk of injuries.
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body → describe → injuries
Olympic and world champion Jonny Brownlee acknowledges under-fuelling mistakes he made in his triathlon career contributed to serious injuries.
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he → acknowledge → injuries
…and 65 more, not listed.
The Aporia
