“I pushed through the pain”: Britain’s distance runner Pippa Woolven shares serious health struggle with RED-S that almost broke her

For any athlete, the best way to improve their performance is through training.

Exercising helps them to build up stamina and muscles as they work towards their goal.

Now imagine that instead of getting stronger, faster, and better, training takes out most of your energy, leaving you constantly exhausted, prone to injuries and miserable.

As many other athletes, you keep “pushing through”, ignoring the adverse effects on your physical and emotional well-being.

With no diagnosis, Pippa Woolven kept on training hard until her body caved in and she could no longer pursue her passion.

The British long-distance runner was forced to quit and painfully lost sight of her Olympic dream that was within grasp.

“It took a long time to even become concerned about it because a lot of the initial symptoms are things that an athlete might expect to experience on a daily basis like fatigue, injuries, illness, low moods, an obsession with food and nutrition,” Woolven told Olympics.com in an exclusive interview.

Despite getting the all-clear from several medical and psychotherapists, it took her four gruelling years to put a name to her condition. Relative Energy Deficiency in Sport - commonly known as RED-S. A condition of poor health and low energy that acutely affects athletic performance.

“When I found the term RED-S, which was much broader and encompassed all the low moods, the fatigue, the unexplained performance decline, it was just like a eureka moment,” she continued.

That discovery set Woolven on an enlightened self-discovery path and stoked her desire to create awareness about RED-S, that affects training and performance, especially for endurance athletes.

Pippa Woolven: The making of a steeplechaser

Woolven was a top-performing teen, a budding 3000m steeplechaser. A pro track career became a real possibility that even earned her an athletic scholarship at Florida State University.

The girl who began running aged eight enticed by a promise of a slice of a chocolate cake at the end of the race, developed to be a top achiever.

Between 2012-2014, Woolven was the top-ranked U20 in the UK with her personal best of 6:36.60 in the 2000m steeplechase and No.3 in Great Britain in the 3000m steeplechase.

Qualifying and competing at the 2012 World Junior championships was one of her career highs and when she earned the scholarship, she embraced it as an opportunity to build on her talent and better her running times.

Then she began to struggle while training. And it significantly impacted her performance. She knew something was wrong. But she couldn’t figure it out and didn’t know how to get the right help.

“I would get injuries that I didn't frequently get before regularly, and they would take too long to shift,” she recalled. “I got tired, an abnormal amount. You expect to be fatigued as an athlete.”

“I was very open about what I was experiencing. I had this big support system around me…I was relatively new there (at the Florida State University) and I felt that often their interests were simply to get me back on the field of play, to just get me racing so that I could win points and do well for the team. That often came in the way of my overall well-being and health.”

Even after finishing her scholarship in the US and returning home to pursue her degree in Sports Science at the University of Birmingham, her struggles persisted.

“I did share my symptoms widely, but nobody really could piece them together.

"Things like low iron levels I was starting to suffer from, and I would just have injections. And that sort of masked the underlying issue, which was - why am I getting low iron levels? why can't I absorb this essential nutrient?”

Woolven was desperate to maintain the typical lifestyle of an athlete.

“I was about 18 when I went on the contraceptive pill. Before then I had had natural monthly menstrual cycles, and everything was fine. I went on the pill because I believed that it would give me this performance enhancing benefit so that I could tailor my periods around my training.”

She persisted even though she was not achieving the benefits she hoped to achieve from her workouts.

“When I started to feel really bad, I kept thinking I have to push through,” she said.

“And because often in training you suffer, you feel pain, and if you endure it, you're rewarded, I couldn't get out of my head that maybe I just needed to work harder or get fitter and I would come through the other side of whatever this was.”

Then suddenly, the team GB cross country runner and steeplechaser couldn’t run anymore.

“I was so fatigued that I couldn't push through and that was what I cared about the most,” the 29-year-old said in an interview on her struggle with the unidentified condition then.

“At that time, I would have done anything to run again. I just pushed on and in between doctor appointments, because there was no definitive answer, and there was no diagnosis.

"I didn't realise the harm that pushing on would do to me in the long term. I just carried on and eventually, it became so bad that I couldn't train, I could barely function day to day. And I lost sight of all my dreams.”

Woolven’s 'eureka' moment

After qualifying for the 2014 Commonwealth Games in Glasgow, where she made the steeplechase final, the Woolven had big sporting dreams.

And following her fifth-place finish at the London 2012 Olympic Trials, she strongly believed she had a decent shot at making Rio 2016.

But her health setbacks endured.

“Rio was a realistic possibility after the Commonwealth Games. It just seemed like the next step up. It was my dream. It was my entire identity.

“I just thought, I'm going to have to walk away, and I've got no choice,” she said of her premature retirement after the Commonwealth Games.

“It was so debilitating because at this point I still didn't know what was wrong. I had to go out into the working world and get a job. And it felt like I would never run again, at least to a high level. It was hard.”

Her symptoms stretched. Her body also caved in, but the never-give-up attitude that had carried her through the years wouldn’t allow her to just walk away.

She buried herself in researching the physical and psychological symptoms that were affecting her performance.

The runner stumbled on online articles and blogs on RED-S that matched her symptoms.

It is a condition triggered by severe energy deficiency, mainly caused by a mismatch between dietary energy intake and energy burnt while training or competing.

“The most shocking discovery has been how similar every female's experience is. And yes, everyone is individual. And males can suffer from this as well,” said Woolven.

“But when I read an email that comes in from a female athlete, it's almost as if I could have written it. It gives me goosebumps when I read them because they're all the same. It always starts with the best intentions to be faster, to be better, and to be more healthy. And it always ends in disaster.”

The Buckinghamshire native was finally diagnosed with RED-S, a condition that the International Olympic Committee (IOC) in 2014 defined as “an impairment in physiological functions consisting of, but not limited to irregularities in metabolic rate, menstrual function, bone health, immunity, protein synthesis, and cardiovascular health.” IOC also emphasised that the syndrome which can manifest as the Female Athlete Triad affects both males and females.

Pippa Woolven - Spreading the word and helping others

The diagnosis was a huge relief for Woolven. But rather than rush back to the track, she took time off to recover but more importantly to understand and create awareness on an experience that robbed her of her joy of the sport.

“I was probably diagnosed with it in 2017 and it took me a full year to recover and get to a high level again in 2018. And then I've only just retired in 2021,” said the silver medallist with the British Team at the 2018 Euro Cross Country Championships.

Amongst women identifying Red-S can be simple as it disrupts a woman’s monthly cycle and causes Amenorrhea (irregular or loss of monthly period).

In men, it also affects the reproductive system. There’s decreased testosterone while generally apart from fatigue, weakened immunity, and weight loss, the disorder similarly causes stress fractures in athletes.

“It does sound scary, and nobody wants to suffer from it. But the best thing is that you can recover, and you can't say that about every medical condition.

"We need to start talking about it as an injury, a metabolic injury, and not a psychological one, because ultimately it is a physical condition."

Woolven launched an organisation Project RED-S that provides information, advice from medical doctors and support. Her main aim is to provide resources.

“We have three goals and they're very simple - awareness, prevention, and recovery. But it all starts with knowing what this problem is and then you can prevent and help recover from it.”

She also believes it is important to educate coaches who can spot the problem and direct their athletes to get the right support.

“My dream would be for every athlete, for every coach, for every stakeholder, every official and governing body employee to know what RED-S is,” she underlined.

“Coaches, we can't expect them to do everything…they're not doctors, dieticians, but they at least should know what to look out for and where to send an athlete for support if they think someone's struggling. And just to open up conversations, we should all be knowing if our female athletes are having a natural, healthy menstrual cycle. And we shouldn't be afraid to talk about it.”

IOC consensus on RED-S

There has been increased awareness within sports, especially since the original publication of the IOC consensus statement on RED-S in 2014 that was updated in 2018, but still a lot more needs to be done.

Ahead of the 2019 World Championships and the Tokyo 2020 Olympics, World Athletics released a consensus that highlighted new insights around the deficiency.

The word is out there for athletes in endurance sports from running to cycling and those competing in weight-classed sports like rowing, but there is still a need to reach out to the masses who may not be able to identify their low energy and the effect it may have on their well-being and even their fertility.

“If you see a skinny distance runner on a start line, you don't often think to question, are they okay? Because you expect them to look that way. I'm keen to represent every type of individual who can suffer from this.

“Black athletes, Asian athletes, disability athletes. It's not just your white female middle distance runners,” said Woolven, adding that despite the mental element RED-S needs to be treated holistically and not “stigmatised in the same way that eating disorders have been and other mental health issues”.