It wasn’t until two years after retirement, and having her daughter Ida in 2019, that Nikki Brammeier realised that she had been suffering with Relative Energy Deficiency in Sport, or RED-s, for most of her career.
“I think for me, the realisation that I had RED-s and just how much I struggled with my weight and things throughout my career really only became apparent after I'd had Ida,” she says. “Because about six months after she was born, I started to go back into those habits of not eating properly, or I'd just skip meals or I'd make an excuse and be like, 'I'm busy with Ida I can't eat' or I'd be riding my bike or running and it was all to do with my weight.”
Brammeier winning the 2013 British National Cyclocross Championships (Photo credit: Alex Broadway/SWPix.com)
Luckily for Brammeier, she was aware of the dangers and was able to catch herself before lapsing too far into old habits: “I realised that I just needed to kind of change my habits again, and work at things.”
In a 2014 statement on the reclassifying of RED-s (formerly the female athlete triad) the IOC described the cause of the condition — which affects both males and females — as “energy deficiency relative to the balance between dietary energy intake and energy expenditure required for health and activities of daily living, growth and sporting activities.” In other words, not eating enough to fuel your lifestyle.
While listening to podcasts and reading up on the condition Brammeier realised that, “pretty much every single symptom that they were talking about, or that was stated when you read up about it, I had throughout my career.”
Brammeier had already been sharing training advice on her Instagram page with particular emphasis on the menstrual cycle, which allowed her to easily segue into creating awareness around RED-s: “I think just talking about all that allowed me to then talk about the RED-s,” she says. “Because when I was speaking about the menstrual cycle and all the different phases so many girls were messaging me saying ‘this sounds amazing, but I don't actually get my period.’”
For women, one of the key warning signs of RED-s — the consequences of which can be life-changing if left untreated — is amenorrhea, or lack of a period. For the final two years of her career, Brammeier tracked her menstrual cycle and planned her training and racing around it. “I had an awareness of my menstrual cycle at the time because it had come back,” she says. “I’d write notes in my training diary about what phases I was in and maybe how I’d feel around that phase and I synced my cycle to my races in that last season.” Although she stressed that this was her own initiative and not that of a coach.
Prior to those two years, Brammeier spent between the ages of 23 and 29 rarely having a period, “My period just stopped and I probably didn't have a period for two or three years and never even thought anything of it.” She recalls seeing a gynaecologist in Belgium who told her that her body wasn’t producing any oestrogen, “but they said to me at the time, 'but don't worry, it's totally normal. You're a sports woman. So you're probably training quite a bit, you need to watch your weight, so don't worry about it.'”
For Brammeier, at the time, the impact of that appointment was minimal, “It didn't even shock me into thinking like, 'why is this happening?' I just kept on going with training and not really eating much.”
Photo credit: Alex Whitehead/SWPix.com
On the 19th January this year Brammier posted a photo of herself winning a cyclocross race accompanied by a long caption, part of which said: “Once I began training properly, which probably wasn’t till I was in my early 20’s I thought fuelling my sessions meant eating the least amount of food possible to get me through. I feel this is still a mindset for so many cyclists and to put it lightly, this is utter nonsense. To train and race, we need to fuel our body with good nutritious food, food that gives us energy, not that takes it away...It’s true that power to weight matters, but not at the cost of our health. If you want to stay in this sport for a long time, you need to fuel those sessions.”
“The thing is, you only have one cycling career,” she says now. “And at the time, you're just like, 'I need to do everything I can to be the best' but a lot of the time you see riders just fade into the background after a couple of years, probably because they're just so burned out, or they end up wanting to finish cycling early because they're just so over it.”
At this point, one might wonder why Brammeier didn’t receive guidance from teams or coaches on her health during her career as a pro. She recalls a discussion she had with a coach, aged 18, while she was part of the national team: “I always remember going into this room with a coach and, they probably said 1,000 things in there to me,” she says. “But one of the things that they said is, 'I don't think you should do mountain biking because you're too big.'”
It was a moment that would define the way she thought about her body thereafter, “I was 18 years old, having that one comment stayed with me for pretty much the whole of my career, thinking that I was always big even if it just meant that I was tall,” she says. “I just never had a problem with eating until that point.”
Photo credit: Alex Whitehead/SWPix.com
Part of the problem, Brammeier believes, is the nature of the relationship between athlete and team wherein the athlete is often viewed as a race-winning entity — or commodity. For her, teams and national federations should invest in their athletes’ overall health. “I think teams need to have the responsibility — and national teams need to have the responsibility — of making sure a rider is healthy on that start line,” she says. “Power to weight is important, but it's not more important than anything else.”
“I'm sure there could be things in place where teams have more of a responsibility of actually looking after the riders. If they're prepared to pay them a wage, they should be prepared to look after their health as well.”
The practicalities involved in implementing a safeguarding system around RED-s and eating disorders in athletes are complex. In an article on RED-s featuring the middle distance runner Bobby Clay — who suffered from osteoporosis and possible infertility as a result of RED-s — Telegraph Women’s Sport reported that Norway is the only country in the world to have set specific limits on preventing athletes suffering with RED-s from competing.
The Norweigan federation, they say, use BMI as a metric, but Brammeier is skeptical, “I think BMI is a tough one because I don't think you get that much information from it,” she says. She suggests tracking hormones through blood testing as an alternative, as well as general body composition and talking to athletes. “You can ask a female, ‘do you have a period?’ ‘When was your last period?’ If they say ‘no, I don't have a period’ and a lot of the blood values are low or you don't see any oestrogen in there, these are red flags, and then you realise that maybe they need a bit of help.”
Crucially, she believes that sidelining riders is not the answer, both because of the prevalence of RED-s (“I think you'd end up with like half the peloton — or maybe not even that — starting those races”) but because doing so would not address the root of the problem. “It’s actually working out the reason why they’ve got into those behaviours and what their thoughts are around why they’re doing that in the first place,” she says. “Giving them support and giving them the information needed to show what is healthy and just having more help around racing healthy.”
Brammeier at the 2018 cyclocross World Championships in Valkenburg. Photo credit: Alex Whitehead/SWPix.com
Brammeier is adamant that it is possible to reach the top of the sport in a healthy way. “There are riders who do race healthy, there are riders that will have a period. And that will be at the top of the sport,” she says. "To be at the top and to be racing with the best or, to be honest, whatever level, you need to be healthy.”
Her hope in speaking publicly about RED-s and the menstrual cycle is to increase awareness of the dangers of the condition and facilitate a movement towards a healthier, more balanced peloton. For Brammeier, the aim is not just for the current crop of riders to benefit, but for younger generations to have healthy role models. "They'll start to understand: 'oh, yeah, I don't need to absolutely starve myself and train like crazy and never rest to be to be as good as them'.”
Hearing from riders themselves would also be beneficial. “I think sometimes it does take just a few riders at the top of the sport speaking up about these things,” she says. “Because the next generation are going to be looking at those riders to be role models, and if they hear their role models talking positively about food, or about health, or about what it takes to be a strong bike rider, everything that goes with it, I think that's inspiring for them.”
For her part, Brammeier is using her position as a coach to instil the healthy attitudes she wishes she was able to implement in her own career: “I just try to mentor the riders,” she says. “Obviously, I give them a training plan but I try to be open about everything from the start; talking about the menstrual cycle, talking about fuelling, and talking about what it is to recover. Just everything that I learned in my career.”
Ultimately, Brammeier’s message is that overall athlete health, mentally and physically, is key to career longevity, “Surely, you should aim for riders to be finishing happy at the end of their career and proud of what they've achieved, finishing healthy. But so many riders don't.”
How to achieve that is something that Brammeier doesn’t have the answer to. For now, her goal is to start a conversation that might lead to tangible change: “I feel just that something needs to be done about it. I don't know what yet, but I think just talking about it might start something up.”
“Hopefully, in the next few years, the more this is out there [the more] people will actually start to realise that this is something that needs to be recognised.”