From Burnout to Breakthrough: How Nutrition Helped an Ultra-Runner Conquer REDs

Cushla Holdaway is a highly respected sports dietitian renowned for her expertise in helping athletes optimize performance and wellbeing through evidence-based nutrition.

With years of clinical experience and a deep passion for endurance sports, this week, Cushla shares the story of a client who discovered she was suffering from REDS - Relative Energy Deficiency in Sport - which affects males and females in sport - and the 18-month process to recover from its effects. 

Cushla writes:
Annie* was a passionate ultra-runner. Most weekends, she could be found winding through her local trails with the crunch of gravel underfoot. She had only recently embraced running in the last couple of years with a determination to improve especially with her early races showing promise!

However, this all came to an abrupt halt when she was unable to shake significant fatigue after her long runs, being sick every other week, menstrual irregularities, and suffering from low iron.

Just when she thought she could keep training through it all, she suffered a bone stress injury, forcing her to stop running entirely. The trails that once fuelled her fire now seemed like distant memories and the upcoming races and adventures with friends now completely off the cards.

It was only when Annie sought help from a sports dietitian that her story took a pivotal turn. Working alongside myself and a dedicated medical team, she faced a harsh truth…Relative Energy Deficiency in Sport (REDs).

Her body, starved for adequate fuel, had begun to shut down vital functions. Much like a phone in battery saver mode, her screen light was dimming and background apps were shutting down. Her body was doing everything possible to conserve energy and her health was suffering as a result.

The following 18 months were a journey of resilience. It was tough for Annie to learn what it meant to nourish her body enough for recovery, patiently waiting for her period to return, and ongoing hope of being able to return to training as each month went by. She had to confront her relationship with food and challenge harmful beliefs around fuelling and body image. The recovery process included endless moments of frustration, doubt, and perseverance, but each small victory fuelled her return to running.

Slowly, her body began to heal. After a long break from structured training and a heavy focus on nutrition, her energy increased and everything started to improve including her mood, biomarkers (e.g. iron), sleep, focus, and daily energy. After many months her menstrual cycle finally returned as well.

Finally, 18 months down the track she was able to get back into consistent training crossing a different finish line of a race she didn’t think she would have to endure, but feeling the best she had ever felt.  

Today, Annie runs better than ever before grateful for her renewed health and resilience. Her journey reminds us all that even in the face of setbacks, recovery is possible with support, patience, education, and appropriate care.

Unfortunately Annie’s story isn’t a unique one. Many athletes face similar battles, whether intentional or unintentional, under fuelling can destroy sports careers temporarily or permanently.

REDs is a silent threat, but one that can be overcome if we listen to our bodies, increase awareness and seek support early.

If you resonate with Annie’s story please don’t wait. Reach out to a sports medicine professional or sports dietitian. Your health, passion, and future depend on it. You can read more about REDs on the HPSNZ page here.

*Name changed for confidentiality, with permission to share.

Cushla (left) is an Accredited Sports Dietitian based in Mid-Canterbury, specialising in nutrition for endurance athletes from beginners to elites. Cushla is also the dietitian for the New Zealand Defence Force (Burnham), runs online education courses, and hosts a podcast ‘Nourish Your Potential.’

With a BSc in Human Nutrition and a Master of Dietetics (dist), she offers personalised consultations across New Zealand, both in-person and online. 

Passionate about running and evidence-based nutrition, she helps athletes optimise performance and health through practical, realistic, and individualised advice.