Niamh Donnelly explores disordered eating in male athletes, a condition that is more prevalent in Ireland than we think. She speaks to experts and sportspeople to learn more about the condition, often perceived to affect females only
If I could go back, I would stop trying to be as lean as possible. I would stop being on Instagram. I was looking in all the wrong places for information. I would go back and make sure I focused on fuelling, supporting myself and making sure I got everything that I needed because I definitely wasn’t doing that. In hindsight, I can see it, but it wasn’t obvious at the time. I remember waking up one day after having had a vomiting bug and I looked very lean in the mirror and I was delighted. Like, that’s ridiculous. If someone said that to me now, I would suggest they go straight to a psychologist. It was so normal for me to think that. I never even said it to anyone.”
These are the words of Evan Lynch, a former Irish international racewalker, who now works as a sports nutritionist and dietitian. He has many insights, from both a professional and personal standpoint, about body image and disordered eating among male athletes. It’s not an easy thing to talk about, nor to detect, but Lynch is convinced it’s more widespread than it seems.
“I think the topic of disordered eating in male athletes is important because of the bravado that exists in that world. How you look, how fast you are, how lean you are – they’re almost used as social currency. ‘Oh your man is ripped, he must be a great athlete’ or ‘he’s in some shape, I’d say he does better with women’. There’s an unspoken hierarchy in male sports. Leanness is equated with being a better athlete – sometimes a better person, if they’ve a pathological outlook on it.
He continues: “The other reason disordered eating in male athletes needs to be looked at is that it tends to go unnoticed. But stress fractures happen in lads too, not just women. Relative energy deficiency in sport (RED-S) happens in lads too, not just women. The reason it goes unnoticed in men is that men don’t have menstrual cycles and loss of menstrual function is like the big worldwide red flag for potential energy problems.”
What is RED-S?
Relative Energy Deficiency in Sport is a low-energy condition that results from insufficient caloric intake and has many adverse physiological effects.
Amy McGuire is a performance nutritionist and lecturer at Limerick Institute of Technology. She is one of the first in Ireland to study whether there might be a male equivalent to the female athlete triad, a medical condition involving low energy levels, menstrual dysfunction and decreased bone mineral density in female athletes. She is currently undertaking a PhD focusing on low energy availability (LEA) in male endurance athletes. LEA is categorised as having fewer than 30 calories per kilogram of lean body mass per day. This is a really new area of research, McGuire says, whereas the female athlete triad has about 20 years of research behind it.
McGuire is studying Irish endurance athletes across a variety of sports, including running, cycling and racewalking. She is looking at prevalence plus association. So, is LEA there? And if it is, what effects might come from it? McGuire’s research is still in the early stages, but preliminary data show some deeply concerning trends. “The majority of the athletes that I have tested all had low energy availability,” she says. In one extreme case, an athlete described as ‘world standard’ by McGuire had just four calories per kilogram of lean body mass available per day.
McGuire studies the effects of LEA using hormone tests to look at things like bone mineral density, metabolic health and endocrine function. “I’m looking at what’s going on with their ability to produce testosterone. But there’s another hormone that comes before testosterone, called luteinizing hormone and if that hormone isn’t switched on, testosterone won’t be produced.” Her interest in studying these effects was sparked by anecdotal evidence of cyclists (aged in their early 30s) falling off bikes and breaking their femurs so badly that they would never compete again. She had also heard of men retiring from sport in their mid-30s, trying to start a family and discovering they were infertile. It will take time to determine if the research backs up these stories, but early research indicates that LEA appears to be prevalent across male athletic populations, in particular endurance and weight-class athletes, and it almost goes without saying that the impact of under-fuelling detrimental to an athlete’s health and wellbeing.
The reasons why male athletes might slip into disordered eating are multifaceted. “There’s no one identifiable causal factor,” says Dr Kate Kirby, head of performance psychology at the Sports Institute of Ireland. “You’d have to look at the environment they’re in, the influence of their coaches and peers. Sometimes, it can be traced back to a simple throwaway comment that was made about how someone looks or how they perform.
“I have also seen instances where an endurance runner may, for whatever reason, be lighter than normal when he achieves a PB, and that becomes a motivating factor to stay at a really low body weight. But it is unsustainable. So, often the weight that athletes think is an ‘ideal’ weight, a ‘fast’ weight, is actually an unhealthy or unsustainable weight, but it is what they are striving for constantly.”
McGuire notices a similar mindset in some of the athletes she works with. They are of a mindset that calories are not positive, so when it comes to the power to mass ratio, instead of working on their power, they’re working on decreasing their mass.
The consensus among a number of athletes contacted seems to be that the problem of disordered eating among male athletes bubbles away under the surface, but there may be some telling signs.
“I got married in 2012,” recalls Brian Maher, Kilkenny City Harrier and Irish over-40 national 10,000m record holder. “We’d made the European cross-country team and my stag was the week before the race. One of the lads asked me if I would have any problem if he brought his weighing scales with him on the stag party? And I was like, ‘why would you do that?’ And he told me that he was conscious of his weight. This is a week out from the race. And this is somebody who plans everything meticulously. I told him to either stay at home or leave the scales at home and the scales did stay at home. But there are people like that out there. If I wasn’t friendly with that guy, I wouldn’t have known that. But there are guys out there who are still in the closet about it. They do exist.”
Mitchell Byrne, Rathfarnham WSAF AC athlete and former US scholarship athlete says he knew an athlete in college who stopped drinking milk. “This might sound stupid, but he stopped drinking milk because he heard it might make him heavy. I remember him saying that to me and I contemplated it for maybe a couple of days. Every now and then I thought about it. And I remember saying to myself: it’s milk! But it’s probably an insight into the length someone might go to.”
Credible and trustworthy
When it comes to fuelling our bodies, there is a lot of information – and misinformation – in circulation. “What is happening now is that there are a lot of individuals on Instagram and Twitter [giving information] and people will listen to them without really knowing what’s behind it,” says Raheny Shamrock AC and Irish international, Kevin Dooney. “You have to be more selective of who you choose to work with. You need people you trust, not just people with a social media following. That goes across the board for training, physio, strength and conditioning, whatever. You need to be very careful of not taking as gospel what you hear on a podcast or see on Instagram.”
And it is often the case that sub-elite-level athletes are the ones who suffer the consequences of poor fuelling, or disordered eating, notes Kirby. While these people are very dedicated to their sport, they don’t always have the correct resources around them. “It’s a very difficult area for coaches who are working with athletes who aren’t quite at the level where they have access to a regular physio, doctor, dietitian or psychologist. They may not know who to turn to. It’s hard to know who the experts in the field are if you’re not in the system,” she says.
“I’m doing some work with the charity, Bodywhys, at the moment. We’re developing a workshop for coaches to help them learn how to identify signs of people with disordered eating, how to approach conversations with athletes, and how to access resources that might be helpful.”
A fine line
But, even athletes who are well informed and have good intentions can be caught off guard. Eoin Everard is a sub-four-minute miler and two-time national champion over 1,500m, as well as a chartered physiotherapist and health-and-fitness expert. He tells me he’s always had a healthy relationship with food, but found himself caught out one season having read the book The Secret Race, by Tyler Hamilton and Daniel Coyle. This incredible book about the Tour de France exposed the serious doping culture that existed in cycling. It told the stories of cyclists who went to great extremes, risking their mental and physical health, to achieve their goals – taking drugs to get their red blood cell count up, to increase their power on the bike, and to make themselves as light as possible. “Now I was never going to take drugs, but I was like, ‘you know what, I could lose weight if it’s really going to make that much of a difference’.” One training camp, he gave up bread and tried to go low-carb. “That indoor season, I ran like a donkey and I think that was the main reason,” he says. “I think with running, even more than cycling, you need energy. You need that carbohydrate.
“I had it another time, unintentionally when I went on holidays to Vietnam during a season. I was trying to eat but when you’re abroad you’re walking and touring, there was high humidity, and I was still training really hard.” When he returned home, he found he had lost almost six kilogrammes. “I ran like an absolute donkey. I was running times I wouldn’t even run when I was 16. And I would have trained really well.”
The thing with athletes is they are dedicated and driven people who are often willing to do whatever they can to shave a few seconds off their personal best. “I mean there obviously are two sides to it: the mental health problem of eating disorders versus just people who are trying really hard to drive fine margins,” says Dooney. “At the high-performance level – the very, very sharp end – you do have to look at every single thing in your life if you’re talking about medals and qualifying for global championships.” But having competed at a high level himself, he reasons: “From a high-performance point of view, I kind of chose to enjoy what I was doing. Ultimately, there are stones you could turn over in terms of looking at exactly what it is you’re putting in, and daily calorie counting, but that will just do your head in and have you going round in circles trying to find every single little answer.”
Maher agrees: “I find if you start thinking about race weight, you’re only - excuse my French - mind-fucking yourself. It’s just another thing to trip you up. It doesn’t need to be there. I’ve never weighed myself trying to get fit, ever. It just never dawned on me.” Maher says he’s always had a very simplistic view of fuelling. He has coeliac disease, but to make sure he gets enough of everything he needs, he simply eats two dinners a day. And he’s not afraid to treat himself. “I’ve a kind of fool-proof plan: if I run well, I treat myself with something [like a bag of dolly mixture] and if I run poorly, I commiserate [with a bag of dolly mixture].” The simplicity of his approach is possibly key to his longevity in the sport. Just hours after our conversation, a celebratory bag of dolly mixture is on the cards as he breaks a national over-40 record in the 10,000m.
Spotting athletes who have LEA can be difficult. “The problem is it’s not sexy enough,” says McGuire. “It’s nearly so common sense that it’s boring for some people. But the things we need to look out for are tiredness, increased injuries, increased illness.”
Kirby advises coaches and athletes not to be overly prescriptive about weight. “One of the things we would definitely discourage is being overly concerned with race weight and weighing athletes. I’m always consistently reinforcing the message of health – putting health ahead of performance, which often isn’t prioritised enough in elite sport, I think.”
This sentiment is echoed by Lynch, who now helps athletes overcome some of the same issues he struggled with. “I guess it would be trying to get athletes to see that they are more than numbers, that weight is only one aspect of the puzzle of performance, and that you shouldn’t look at food as a big obstacle or a big anxiety source. It’s there to help you, not hinder you.”
If you need help
Approaching a GP is the best first port of call when seeking help around any eating disorder. This may lead to assessment and referral. The national voluntary organisation supporting people affected by eating disorders, Bodywhys, provides a helpline and email support service: 01 2107906; and [email protected]
Further information and resources can be found on the Health Service Executive website: hse.ie/conditions/mental-health/eating-disorders; or on the Bodywhys website, bodywhys.ie Athletes or coaches who are concerned about the impact of LEA should contact a qualified sports/performance nutritionist who is familiar with LEA, and a GP for blood tests.