Georgie Howe, a promising Australian cyclist, saw her career come to an unexpected halt following a diagnosis of Relative Energy Deficiency in Sport (REDs). This condition, characterized by low energy availability, has sparked a broader conversation about athlete health and the pressures of professional sports.
The first signs of trouble appeared during Christmas 2023, when Howe’s mother, Sally, noticed her daughter’s meticulous approach to food. “She’d stand and stare at the pantry, or open the fridge and just gaze inside,” Sally recalls, pulling out the red scales her daughter used to weigh her food. Despite her concerns, Sally hesitated to interfere, as Howe assured her, “Mum, I’m a professional athlete now, this is what we do.”
By 2024, Sally’s worries intensified after seeing Howe on FaceTime and during a televised race in Belgium. “She wasn’t racing with her usual tenacity,” Sally noted. “She didn’t look like the Georgie we were used to seeing.” The decline in Howe’s performance was linked to her struggle with weight loss and maintaining competitive form, a challenge familiar to many elite athletes.
The Pressure of Perfection
According to Renee McGregor, a specialist in sports nutrition, such behavior is typical among elite athletes. “They will be high achievers, critical of themselves, perfectionists,” McGregor explains. “That works for them – until it doesn’t.” The role of health teams is crucial in teaching athletes when to push forward and when to prioritize their health, a task complicated by the short time frames and the subtlety of REDs symptoms.
Luca Pollastri, medical coordinator with GreenEdge Cycling, acknowledges the difficulty in deciding when to pull an athlete from competition. “We use red and yellow flags in our assessment,” he says. Red flags, such as a significant drop in body-fat ratio or prolonged absence of menstruation, are clear indicators. However, yellow flags require nuanced judgment, often relying on trust between the athlete and medical team.
The Complexity of REDs
REDs, a clinical diagnosis of exclusion, revolves around low energy availability (LEA). As sports dietitian Louise Burke explains, “It’s not eating enough for all that training.” While some LEA cases are intentional, others arise from unintentional under-fueling due to intense training demands.
Pippa Woolven, who runs the Project RED-S website, shares her decade-long recovery journey from REDs, emphasizing the importance of challenging internalized beliefs about nutrition. “I had to show myself that if I ate properly, nothing bad would happen,” she says, now embracing a healthier lifestyle.
Debating the Existence of REDs
José Areta, an associate professor in exercise physiology, questions the singular focus on energy deficit as the cause of performance declines. His research highlights the complexity of factors affecting athlete health, including stress, lack of sleep, and other medical issues.
Areta’s study on Howe during the 2023 Tour de France Femmes illustrated that high performance can coexist with energy deficit. “Would she have performed better if she’d had more food? We don’t know,” Areta states, acknowledging the competitive advantage of being lighter.
Looking Ahead: A Call for Comprehensive Research
The debate over REDs underscores the need for more research, particularly concerning female athletes. “Women are not small men,” says physiologist Stacy Sims, advocating for tailored approaches to women’s health in sports.
As the number of women in sports rises, so does the call for research into the genetic and physiological factors influencing REDs. “What price are you willing to pay to win the race?” Areta asks, urging a reevaluation of the costs associated with competitive success.
In mid-2024, after withdrawing from her final race, Howe began a journey of recovery. She spent time in Paris with her family, gradually rediscovering joy in cycling without the pressures of competition. Her mother, Sally, reflects on the experience, emphasizing the importance of health over achievement in sports.
Howe’s story is a testament to the challenges athletes face and the ongoing need for awareness and education around REDs. As she continues her recovery, working in a bike shop and exploring new career opportunities, Howe’s experience serves as a cautionary tale for athletes and sports organizations alike.
