The Cost of Looking the Part
Low energy availability, RED-S, and the hidden trade-offs behind a lean physique and overtraining.
Comparison is the thief of joy. So why are we so good at it?
This industry is militant for that, and we put ourself out there to a lot of scrutiny. Scrutiny becomes anyone’s opinion on what we should look like.
Does having a chiselled physique dictate whether you are a good personal trainer? Because, being a good personal trainer is about the value you provide your client based on what their goal is, no?
Having a physique does show to clients that you have put yourself through the process of getting lean, chiselled, ripped (whatever you want to call it). You understand the discipline it takes to get there and can relate to a client who may choose that as their goal. That’s where the value lies. I always say you can’t coach it if you haven’t done it.
Is that physique easy to maintain and should we stay that way?
Maybe for some, maybe not for others.
We are human, we should also allow ourselves to be clients. I shall reiterate, we meet clients where they are at. Upon their initial consultation we discuss everything from, their career and social lives to their daily excretion habits and coffee spending, their stress causes to their partner dynamics. That discussion is pivotal for us to create a plan that will keep them adherent and not create overwhelm. What is the minimal they can achieve and what is the most they can achieve. What can they do on a bad day and what can they do on a good day. Ranges are so important to set, no variables are the same each day for a lot of people.
As coaches we hold ourselves to high standards, we can showcase the discipline to achieve the results but, I don’t think we’re as kind to ourselves as we need to be or practice much of what we preach to clients in terms of sleep, stress and recovery, We’re just as bad. We just paint it differently. it’s hidden behind being strong — or being jacked. We are most certainly a percentage of people wired differently. Missing workouts is non-negotiable or it will be slipped somewhere else in the week if missed. Meal prepping is always done with a little leeway (10% at best).
What is healthy and who dictates that?
Or is it just me that is still calorie counting and torn between having sculpted abs but chasing deadlift numbers and a Hyrox?
Historically I have suffered from disordered eating yet somehow, I ended up in this profession as training was an escape for me before I began using it as a purge and, eventually overcoming it. I built an unhealthy obsession with abs, wanting to be shredded, because I believed my body was my worth. The rise of social media further fuelled that before I cleaned up what my feed was showing me.
2 years ago, I participated in a photoshoot for work / with work, I got myself to possibly >15%, we didn’t get a chance to do a final set of measurements to confirm this however, I had lost 5.5kgs on my already petite 4-foot 10 frame. That IS a lot on a smaller body and it required me to dial in my calories significantly and unsustainably. The result, a set of sculpted abs, a defined back and, popping delts. Not forgetting, the loss of my period too. I regained my period after only a month and this was because I rebounded hard. I was unable to manage the process of coming out the shoot phase. The rebound provided my body with the energy that it needed and also signalled that it was safe for my endocrine functions to restart. As we approach another photoshoot, I reflect back on my last experience and I have a few questions.
What body fat percentage determines whether your abs will be visible?
What is a healthy range body fat for women?
What happens when women reach low levels of body fat?
What are the immediate and lasting impacts of low body fat?
Before I answer these questions or rather present my research that answers these questions, it is worth understanding what is happening beneath the surface. The issue isn’t just body fat; it is energy availability and, how the body responds to it
When energy intake and energy output are mismatched — something known as low energy availability — the body begins to prioritise survival over function. In women this causes a disruption to the reproductive cycle. In the research this shows up as two frameworks:
- Functional Hypothalamic Amenorrhea (FHA)
- Relative Energy Deficiency in Sport (RED-S)
RED-S is predominantly caused by Low Energy Availability (LEA).
FHA is associated with three recognised causes:
- Weight loss or disordered eating
- Exercise related and, psychological stress
The first two cause LEA from caloric restriction and high energy expenditure. While the latter is independent of energy status. Either way all three routes can arrive at the same endpoint. At a basic level, the brain stops sending the right signals. The hormone (GnRH) responsible for regulating the menstrual cycle becomes suppressed. Without those signals, the entire chain is disrupted, impairing ovulation, hormone production, and eventually the menstrual cycle itself.
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The biggest concern is the effect on bone health or bone mass density (BMD). Peak bone mass density is reached by age 22 and, from age 30, BMD starts to decline. We are encouraged to build muscle to protect this yet, could we be harming BMD IF we are overdoing it and unaware? Combined with perimenopause, I am a little concerned. The loss of periods can significantly decrease BMD and this decline can happen within 6 months of not having a period. If we observe females in adolescence, this period is critical for building peak BMD and FHA/RED-S poses serious harm as they grow into adulthood. Should our menstrual cycle return, full BMD restoration is not guaranteed. A study of former amenorrhoeic athletes confirmed irreversible bones loss despite menstrual recovery.
To simplify the further effects without reaching too far into all the science, the concern extends beyond the loss of the menstrual cycle. Research into both frameworks pose long term cardiovascular disease risk and endothelial dysfunction (inner lining of blood vessels), with some effects beginning far earlier than many women believe.
Where does body fat sit in all of this?
Essential fat is 12–17% depending on age. These numbers represent the biological minimum for women’s hormonal and reproductive functions. Less than is noted as clinically dangerous. My scouring the internet for all the right sources shows that body fat percentage isn’t what drives the harm, LEA is;
- You could be lean (15%), fuelling well — and be fine
- You could be lean (15%), under-fuelling — you are at risk of RED-S.
- You could be ‘normal’ (22%+), under-fuelling — you are at risk of RED-S and this is often missed.
- If you are at a very low body fat %, regardless of energy availability you are at risk as you are within what is deemed clinically dangerous body fat levels.
Essentially, body fat loss and rapid body fat loss accelerates LEA driven HPO (hypothalamic-pituitary-ovarian) suppression so it is rather how we lose the fat that determines what is healthy and also how individual it is to the person.
If we’re talking client this is where having a clear understanding of their life and stresses comes into play and how we put them through their diet phases. It will be understanding blood panels throughout their diet cycle. We know in the latter stages of a diet we talk about LEA being normal but the question is, should we normalise it knowing what it can cause? Or is it that we don’t know and understand the impacts of LEA? I haven’t researched this in men as yet so bear with me. I know having read, researched and written this article I would approach women who want to diet down differently.
Relating this back to myself. Instagram — or maybe it is my algorithm — throws me shredded women that are lifting heavy, running and entering competitions. Have I really stopped to consider their lifestyle or if they are/aren’t suffering from RED-S or body dysmorphia?
They may well be in that perfectly healthy category, fuelling and recovering well. We’ll never know but, I look at that and yes, I wonder why I am not able to achieve that.
Two months ago, I had my bloods taken as a result of constant fatigue, even when well slept. I was unable to train the way that I know I can. This happened last year, my strength took a complete drop however, this time I was able to recognise those familiar symptoms. Low serum ferritin, 14, below the threshold which, despite my symptoms (I have other symptoms too) wasn’t taken seriously given my active lifestyle and job.
My cycle may still be present, but a regular cycle isn’t always indicative of normal.
I sit in the category of RED-S because of low energy availability. The impact may still be significant even if the cycle is present. This category is overlooked because everything looks ‘normal’.
If everything should be context-dependent, why are my symptoms being assessed like a textbook case? GPs haven’t taken them seriously (in my new surgery). Is it simply because my menstrual cycle exists?
The presence of my cycle does not necessarily mean energy availability is adequate or health is preserved.
“Menstruation is the last physiological function to be sacrificed in the hierarchy of energy conservation. By the time the cycle stops, significant damage to bone, the cardiovascular system, and iron metabolism has often already occurred.“
— This is a widely recognised clinical principle in the RED-S and FHA literature.
Low ferritin in LEA is not just a performance issue; it is both a consequence and a driver of LEA and carries independent health consequences beyond fatigue.
And this isn’t rare. It just doesn’t look like a problem.
With the rise of women partaking in fitness and fitness events such as Hyrox taking the world by storm, are we equipping them with this knowledge so that they can better structure their training, nutrition and recovery? It isn’t uncommon to see or hear of people who aren’t athletes training twice per day and what are the considerations?
Over the last 6 weeks I have been taking iron supplements every other day and consuming red meat daily combined with vitamin C. I have been mindful to separate anything that may inhibit iron absorption. Soon, I will repeat my blood tests and, request a stool sample to assess the impacts. I can feel my energy levels returning but, I am proceeding with caution. Going backwards isn’t an option.
Note — there’s about 30 papers all this information was collated from.
