Caila Yates: Revisiting RED-S – Myths, Relapse Risk With Injury, Athlete Plates and Intuitive Eating, And Initiating Tough But Helpful Conversations

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We are joined by Caila Yates, a sports dietitian based in Boulder, CO, primarily working with endurance athletes. She has a dual speciality in sports training as well as eating disorders. She has clinical experience working with patients with eating disorders and has a deep understanding of behaviors, disordered patterns, recovery and much more as it relates to eating disorders, especially in sport. In her practice, Caila helps athletes understand their nutrition needs in every season so that they can show up to every practice or race and put their best foot forward. You can find out more about Caila and her services at steadystatenutrition.co, and give her a follow on IG @steadystatenutrition.

On this episode we cover:

-When Cailia reached out to EP she wrote to me that “I have seen countless athletes and coaches look the other way when it comes to underfueling”…. yet … “There is a disproportionate rate of disordered eating among the endurance athlete population.” And I agree. Let’s just start about here and bringing awareness to something so important and so missed in this space. Why do you think this is? I know I have my ideas and I don’t think it’s malicious intent by coaches or athletes, but I’d love to hear your take…

-Let’s talk about your story, what got you into endurance sports… sports dietician… clinical work with EDs and treatment? What led you down that path? Any personal history of those issues or related? 

-What’s your focus in endurance sports and training?

-Before we get into our 2 main topics, let’s very briefly discuss:

1. Define RED-S and why this is now the term to use over female athlete triad
2. How one can identify RED-S symptoms in themselves or others (missed period is just one…)
3. Debunking common myths around RED-S- what are the myths?

-We’ve talked a lot about RED-S amenorrhea HPA axis dysfunction Eds you name it… so today we’re going to revisit that overarching topic but focus on a couple issues that we have NOT covered in detail before:

1.  How to avoid a relapse in disordered eating during an injury

• We’ve talked loads about understanding this condition and steps to healing… but then there’s a whole life after that! Let’s discuss…
• As we know, an injury that takes one out of their sport can be a triggering and devastating event.  As an RD, I tend to see an unfortunate, yet common, pattern when athletes who have a history of disordered eating or an ED get injured.  Hint:  it involves a relapse in DE/ED behaviors.  Many athletes believe that because they are sidelined, they don’t need to (or worse, don’t deserve to) fuel themselves.  This leads to underfueling or restriction, therefore prolonging the healing process.  In order to inform listeners and debunk this myth, I’d love to touch on the following topics during this episode:
  • Energy needs during an injury (Hint: they can be up to 50% higher than baseline needs!)
  • Macro and micronutrients needed to heal injuries, and HOW they work to rebuild muscle/bone
  • Reframing the DE/ED driven thoughts that can lead to restrictive behaviors
  • Preventing future injuries using nutrition interventions
  • AND: 
  • I’d like to add, once training and injury-free again how do we avoid the mindset of using exercise/energy expenditure to justify eating. In other words, how do we shake this cycle that some of us have become so prone and addicted to? 
    • (I personally feel like I have been able to achieve 100% recovery with ED/Disordered eating patterns around exercise/training but I know not everyone believes this is possible, what’s your take on this Caila?)

2.  Using athlete plates to eat intuitively while training

• For those who have a history of an eating disorder or disordered eating, counting macros and tracking intake may not be the best strategy, as it can lead to a hyper-fixation on food while disregarding hunger/fullness cues and cravings.  It is possible to eat intuitively while still getting the nutrients necessary to fuel performance.  Enter:  Athlete Plates is a tool that focuses on the proportion of macronutrients on your plate rather than the grams of this or that that you are eating.  For athletes who are looking for a structured solution to fueling without counting macros, we will focus on the following topics related to Athlete Plates:
  • What are the three types of Athlete Plates, and when should you be using each type?
  • The Athlete Plate link mentioned in our discussion: https://swell.uccs.edu/sites/g/files/kjihxj2576/files/2020-10/hard_%20plate_red_sept15-2017.pdf
  • Tips and tricks for listening to hunger/fullness cues
  • How to integrate things you’re craving into Athlete Plates, and how these things can actually fuel performance
  • What does the research say about the effectiveness of Athlete Plates in training?
  • How to build an Athlete Plate anywhere you go (i.e. traveling for a race)
  • AND: 
  • How long do you like to use this + when to wean off Athletes Plates, eg when does one know if and trust if they are ready to fuel appropriately on their own? Following this forever doesn’t seem like a healthy solution but the timeline may vary?
  • Any other food tracking tools or point in the healing journey in which tracking can help someone? ie further down the road of recovery is it worth doing a day or two of tracking to see if things are lining up in terms of energy balance or let the results speak for themselves? Again, I have my opinion here but love to hear your take!

-Also let’s circle back, if we DO see traits, behaviors, signs and symptoms of RED-S in a friend, fellow athlete, teammate, etc… how do we go about helping this person? What’s the right approach that allows for a gentle conversation to begin rather than driving someone away…

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