I’m on the gradual return to full training by running longer and more frequently each week. The prospect of returning to competitive running is finally looking realistic. Yet in the back of my mind is the worry of another stress fracture and the impact running has previously had on my health.

Is my body going tolerate running again? 

Throughout my journey of recovering from Relative Energy Deficiency in Sport (RED-S), tracking biomarkers have been essential in guiding my medical management, training, and nutrition. 

See related blogs - Brought back to earth - The return to real runningThe "P" Word and When does training become a compulsion? Balancing Rehab & Recovery 

Following a discussion with my coach and doctor, we agreed it would be helpful to repeat previous markers to track my recovery progress. I also wanted to get a full set of bloods to ensure I can be as robust as possible before transitioning back into competition. 

Medichecks- How it works... 

I created a Medichecks account and personal profile by answering questions on my medical history, current health, and lifestyle. This is important because it gives the doctor analysing the results context to ensure any abnormalities are interpreted correctly. I ordered the health tests which would give me a broad insight into my current health and included key biomarkers that my doctor wanted to review. 

The blood tests I needed required a venous sample, therefore I would need them drawn from one of Medichecks clinics. I went to the Doctors Laboratory on Harley Street the following day. With no appointment, needed, I walked in and out within 15 minutes. 

My three vials of blood were sent to the lab and my results were uploaded to my dashboard 3 days later with Dr. Sam Rodgers medical report (see the full list of tests below).

Well Woman Ultra Vit 

Full blood count Red cells (including haemoglobin), white cells & clotting status

Inflammatory markers CRP 

Kidney Function Urea & Electrolytes 

Liver Function & Proteins 

Bone Health* Vitamin D & Calcium

Diabetes, Gout & Heart disease screen Cholesterol, HDL’s, LDL’s, Triglycerides

Iron status Iron, ferritin

Minerals & Vitamins Magnesium, B12, Vitamin D, Folate 

Thyroid Function TSH, free thyroxine & free T3 

Hormones* FSH, LH, Oestradiol, Progesterone

Other RED-S Recovery Markers 

Leptin The "hunger hormone" 

IGF-1 Human Growth Hormone 

* Key marker requested by my doctor for RED-S recovery as recommended by the IOC RED-S 2018 update in the British Journal of Sports Medicine 

Dr. Rodgers Verdict…

I AM HEALTHY.  

My red cells are normal which is always reassuring as I’ve previously had anaemia (low haemoglobin). My white cells and inflammatory markers were also normal. My kidney function was okay, apart from slightly reduced sodium levels (131 mmol/L) which perhaps is explained by the hot weather and losing it through sweat. 

My cholesterol was within normal range, however, my HDL’s (the good cholesterol) was high (2.6 mmol/L) but I was reassured by Dr. Rodgers this was heart protective. I’ve previously had B12 deficiency but my levels are now very high at 252 pmol/L. 

Not to my surprise was my low iron stores. Although within “normal range” my ferritin sits at 36 ug/L and transferrin saturation at 19%. My ferritin levels have never been above 40 and been as low as 9. Since looking closely at my micronutrients, I’m not getting enough through my diet. 

What surprised me was my liver function tests. Having raised liver enzymes isn’t unusual after strenuous exercise, however, I hadn’t perceived my current training to be that taxing on my body. My training sessions leading up to my blood test were easy or steady (Zone 1-3) with an open water swim, easy run and a group ride on the bike. 

Furthermore, my Leptin levels decreased to 0.2 ug/L which is a measure of energy expenditure. Lower levels indicate an energy deficit. My IGF-1 remained steady at 32.7 nmol/l.  Despite eating 2000-3000 calories a day, my training is causing more stress than I thought. My body is clearly working hard to recover (hence the elevated liver enzymes) and consequently burning up extra calories. This also explains why my hormones (FSH, LH, Oestradiol & Progesterone) remain low. 

Definitely some added stress on the body after a nasty bike crash & infected road rash!

My thyroid function was fine. I had expected to see low levels of free T3 which is common with low energy availability, which is perhaps an indication of improvement (although I don’t have a previous result to compare it to) 

For more on Thyroid function, IGF-1, Leptin and The HPA axis I would recommend reading this blog 

What doesn’t fit the puzzle is that last month, I finally had a period! 

Blood doesn’t lie. 

It’s clear that I’m still having problems with energy availability. 

Periods are a barometer to hormonal health. Despite my blood results not being ideal, having a period is a good indicator that I am making progress. This is without a doubt due to eating better, scaling back on training and feeling calmer. 

Action Plan 

Following these blood results, I have a clear insight into the actions I need to optimise my health, performance, and recovery from RED-S. 

These include...

  1. Improve my post-training recovery nutrition
  2. Increase the nutrition density of my meals to meet caloric demands without vastly increasing the quantity of my food, in particular, address lunch and mid-afternoon snacks. 
  3. Add iron supplements (I like BlueIron) and vitamin C for iron absorption
  4. Continue to limit training volume and cut back on cross-training as running load increases 
  5. Improve sleep quality

 Medichecks was an incredibly easy and quick service to get the essential health checks without needing to go through a GP. 

As runners, we carefully track our weekly mileage, training zone, average pace, and lactate threshold. Tracking our health is just as, if not more important to ensure we are on the path to perform to our potential. 

Be proactive, not reactive!