Fueling the ride to excellence: Sara Poidevin and RED-S

But now we know better.

A female athlete who chronically under fuels, whether intentionally or otherwise, will underperform and can expect to experience a variety of other health complications, including a general sense of unexplained fatigue and will probably lack a regular period, which is called amenorrhea. These symptoms, along with a handful of others, are collectively known as RED-S, or relative energy deficiency in sport.

Nearly a decade into her professional cycling career, Canadian cyclist Sara Poidevin knows all about RED-S. She unknowingly lived with it for years and was often confused and frustrated by her inconsistent racing despite her best efforts. The good news is Sara was not only able to recover from RED-S, but she wants to share her experience to help other athletes avoid the same health struggles she battled for years.

“RED-S took my focus away from racing a lot of the time and I lost balance in my life being so hyper focused on nutrition. I think it even limits social interactions in daily life and enjoyment,” Sara says.

“For me, RED-S started when I was first really getting into racing and I would often miss my period for a few months, but it got really serious when I started racing professionally,” Sara says. “My period would come back if I gained weight but once I started racing professionally, it just didn’t come back – until last year.”

For eight years, Sara did not have a menstrual period due to chronic under-fueling. When she first turned pro, she was keen to prove her dedication as an athlete and to improve in every area she could think of. She trained hard and focused on her diet, thinking that if she could be a little bit leaner, her racing would improve. Before she had even realized it, restrictive eating had become the norm for Sara. She consumed the bare minimum, just enough to sustain her through training and racing, but not nearly enough to help her recover properly or to be strong and healthy.

“Food preoccupation was basically constant,” Sara says. “I always wanted to have control over what I was eating and how much I was eating. I was eating restrictively at the time and still trying to find some way to eat less. That really increased my anxiety and then I began having gut issues which caused me so much pain that I was then worried about being in pain and controlling my weight. It was a constant, hyper fixation on everything around food. I never, never felt relaxed when it came to food.”

While a rider’s weight can play a role in her performance, team nutritionist Dana Lis says that its importance can often be exaggerated in a rider’s mind to the extent that it becomes harmful.

“Riders that are locked into losing weight all the time just get themselves into such a hole that they’re not competing well. They’re not reaching their full potential. Maybe they’ll race well for a year and then they’ll crash and burn,” Dana says.

This was Sara’s experience. Her career initially got off to a strong start with podium results but before long, she struggled to find consistency. How well or how poorly Sara was racing didn’t diminish her obsessive thoughts around food. Ironically, she would ultimately arrive at the same conclusion regardless of her results.

“If I was racing well, I would just think that what I was doing was working and if I wasn’t racing great, I would think that I needed to put more effort into whatever eating strategy I was trying to use,” Sara says.

Dana explains that rather than dwelling on weight, developing a thorough understanding of your nutritional needs and how they vary throughout the season and throughout your life will benefit a rider and will lead to healthy habits.

“Riders, especially younger riders, should be focusing on learning how to fuel properly and not so much on body weight,” she says. “Most athletes have bigger performance gains to get from other aspects of their racing and training than their body weight, but I find a lot of athletes will focus on body weight as one of the first things they manipulate. If they don’t even know how to ride in the peloton, it’s not going to matter if you’re two kilos lighter.”

Performance director Chris Rozdilsky agrees with Dana that weight is not critical when he’s considering a rider.

“Athletes need to build fundamentals,” Chris explains. “That's everything from appropriate training loads and recovery strategies, to better understanding the sport itself. For me, as someone who oversees the performance side, I actually don't fixate on power numbers and data for development riders. My priorities are: Do they have the robustness to be able to handle a full year of racing and training? That’s number one. Second is just experience, do they have in-depth knowledge of races, strategy, technical and tactical acumen? Do they know how to be a great teammate and work within a professional sport infrastructure? All of these things are far more important than weight.”

When Sara joined EF Education-TIBCO-SVB in 2022, she knew she had been struggling with health issues but she believed her amenorrhea, gut distress, and fluctuating weight were unconnected. She didn’t realize these were among the signals of RED-S until she spoke with several professionals together.

“Last year when I started the season, we got bloodwork done and some of my hormone levels were quite off. In speaking with Dana and our team doctor, that was a key moment in figuring out what was going on. It was a combination of checking me for the right things but also having professionals who were connected, like how our team doctor is connected with our cycling team and also with a nutritionist,” Sara says.

Once Sara understood that restrictive eating was the cause of her RED-S, she started to work closely with the experts around her, but it wasn’t easy to change her attitude and behaviors overnight.

“It was incredibly anxiety inducing,” she says. “And I really didn’t want to do what they said but I did it because I trust Dana and our team doctor. They are smart people who know what they’re talking about. I needed to listen to the professionals. I’ve tried to implement the changes we discussed as soon as possible just because I was racing and I really wanted to do what I needed to do to race well. I still feel like it’s kind of a work in progress just because of the eating habits that are so ingrained in me, but I think I wouldn’t have been able to race as much as I have without making dietary changes.”

Sara’s RED-S didn’t disappear immediately, but she did start to experience improvements in her health and energy levels, and notably the return of her period.

“My period came back for the first time in eight years the night before the Giro Donne in 2022. I was roommates with Magdeleine and I told her because we had been talking about it. She was so excited for me. I know with a lot of riders in the past that the idea was if you didn’t have your cycle, it’s a sign that you were lean and primed for performance, so I think the attitude around amenorrhea has changed and that’s really positive.”

Sara recognizes how fortunate she is to have such a dedicated team supporting her on the road to health. She also understands that had she had a better understanding of RED-S, she may have been able to prevent it in the first place.

“Missing a menstrual cycle should be your first big, red flag,” says Chris Rozdilsky. “That’s often accompanied by long periods of unexplained underperformance and just low morale, low energy. Those are clear warning signs.”

When it comes to preventing RED-S, Dana says, “nutrition probably plays the most significant role. Energy availability comes from food nutrition. Training and nutrition need to be paired optimally to prevent chronic low energy availability. One of the biggest red flags we see with RED-S cases is eating the same thing, the same amount, every day, regardless of training load.”

While Sara intended to eat to support her training, racing, and recovery, she lacked a solid understanding of what her body needed to reach peak performance and ultimately developed RED-S.

“Nutrition is the difference between being an average athlete and being a great athlete,” Dana says. “One of the things we see is cutting carbohydrates too low. There still is this antiquated mindset that carbohydrates make you fat. They don’t. They are the fuel you need to perform. With trying to avoid RED-S, get enough carbohydrates and starchy carbs. Eat high quality protein at regular intervals every three to four hours, especially during heavy training blocks and stage races. Get enough fats, especially omega three to help with recovery and brain health. Give yourself time to rest.”

Sara developed RED-S because she mistakenly fixated on food in the hope that it would improve her results. In hindsight, Sara says she would have benefitted more had she focused on a number of other arenas.

“On the road, especially when you’re training and racing in North America, it’s really easy to let your technical skills go and to not work on them, so you have to be a lot more deliberate. That really goes a long way once you are able to race in Europe. Also learning how to fuel the day before and during a race. There’s more information now but I feel like I really had no idea how important those two things were when I turned pro. The last big thing I wish I understood sooner was the recovery piece, like learning the importance of recovery, what the best recovery strategies are, and learning how important your sleep is. More training is not automatically better,” Sara says.

Recovering from RED-S will vary from one individual to the next. For Sara, it took a collection of integrated health professionals to uncover her RED-S and then to formulate a plan to get her back to full health. Her recovery is an ongoing conversation that involves continual adjustments to her diet and training.

While not everyone has access to a dedicated team like Sara, there are excellent resources available for athletes. It is also important to recognize that although it seems that male athletes are more resilient to energy deficits before symptoms develop, RED-S is not limited to female athletes.

For sport practitioners and coaches
Performance Nutrition Pros website
Performance Nutrition Pros Instagram

For athletes
Summit Sports Nutrition website

For everyone
Australian Institute of Sport

Live webinar
To learn more about RED-S, Global Relay Bridge the Gap fund will host a webinar with Sara and Chris at 12 noon EST/18:00 CET on June 21. Click here to sign up.