Startled, having just set foot in a doctor’s office for a check-up required by work, my mind went to humor.
“So, you mean like the weight of a house cat?,” I replied.
“Gain some fat, get a cat” became an inside joke between my coworkers and me, a rallying cry preceding many large dinners as we worked in California’s High Sierra.
That wasn’t the first time I heard such advice. In 2016, I was becoming interested in climbing performance and body composition and got a DXA (dual x-ray absorption) scan, a test that measures amounts of fat, muscle tissue, and bone density. For female athletes, body fat between 14-22% is considered healthy. Bone density is measured in “T-scores”, standard deviations from normal bone density, which is represented as 0. A score between +1 and -1 is considered healthy.
At 5’4’’ and 110 lbs, I clocked in at 15% body fat with a bone density score of -1.1, meaning I had low levels of both. The technician asked if I was having regular periods, an indicator of healthy levels of hormones like estrogen that influence bone density.
When I first noticed the disappearance of my period in 2012, I was under tremendous stress due to a debilitating and complex injury. When I regained my health and my periods were still only infrequent, I transferred the excuse from “stress” to “birth control,” as missing periods are a side effect of the pill.
My dismissal of adverse health indicators and my ability to write off the experience as a joke reveals my attitude toward the issue – I didn’t see it as a problem. I’ve always been naturally thin, a voracious eater and often buzzed with an energy that bordered on hyperactive. I ran and eventually climbed to outlet this energy. In college, I earned the endearing nickname “the vulture” because I would always pick off people’s unfinished plates.
In fact, gaining fat has always been difficult for me, with excess calories manifesting as muscle. The doctor’s declaration that I gain weight sounded like an echo of remarks I’d heard from family, boyfriends and friends. Sometimes it seemed well-intentioned, but it also felt patronizing, debasing and pointless – like they were telling me to just “grow taller.”
As I pursued climbing, I was told anything from “you look great and toned” to “be careful, you are starting to look too muscular for a woman,” as if the purpose of my body wasn’t to enable me to perform, but rather to look a certain way for others. Praised and criticized for my natural physiology, I felt pulled in opposing directions, the result being that I stood still where I was. I became hyper-aware of my appearance as mixed messages swirled like violent eddies in my mind. Perhaps my body, lean and potentially beneficial for climbing, and the stereotypical female body I was told was desirable and attractive, were mutually exclusive.
These competing thoughts were white noise against the background of my drive to climb well. Instead of considering the comments that grew from genuine concern, I developed a chip on my shoulder. I felt energetic, was eating well and was doing what made me happy – why would I change for anyone else?
In 2017 I saw a gynecologist to discuss IUDs, a type of birth control. She took one glance at my medical history, four years of infrequent periods, and ordered another DXA to evaluate my bone density. Since the first scan, I had gained weight, so I assumed the problem was resolved. “This is great comparative data!” I thought. The results arrived quickly.
“Significant osteopenia is noted at the spine and hips; there is currently an increased risk of fracture “
In my spine, my bone density was 86% of normal, 87% in my hips and 81% in my neck. I had early-onset osteopenia, a reduction in bone mass preceding osteoporosis, a severe condition in which bones become brittle and fracture easily. I was 26.
A fear dropped in me swiftly and hard. A once distant threat, some imperceptible sensation I could barely recognize, suddenly brandished itself in irrefutable numbers, grasping me by the shoulders and screaming for attention. I felt cheated; my body was silently crumbling away and it didn’t even warn me – except that it had.
It seemed like an irrevocable and destructive force was moving through me. It was painful to even begin to consider the reality that it was I who let it in.
It’s referred to as the female athlete triad,” my gynecologist told me on my follow-up visit.
The “triad” refers to a syndrome that manifests due to three interrelated conditions. Intense exercise and under-fueling, intentionally or unintentionally, can reduce energy availability to a threshold below that needed to maintain normal menstrual cycles.1 As periods become irregular or absent, levels of estrogen and progesterone, hormones crucial in bone formation, drop. In 2014, the International Olympic Committee coined RED-S (relative energy deficiency in sport)2 to replace the female athlete triad, emphasizing that men are also affected by energy deficiency.
My low bone density and irregular periods were two signs of a third inevitability — I had inadequate nutrition to meet my metabolic needs. My body was stopping basic processes and I felt fine, with enough energy to excel in graduate school, socialize, train, and progress in climbing. My mind felt slippery, ricocheting between my perception of my health and the reality unfurling before me.
Professional rock-climber Mina Leslie-Wujastyk touched upon her experience with RED-S in this excellent piece. While Mina noticed low energy levels yet maintained healthy bone density, I had the opposite presentation. However, we both had a normal BMI, abnormally low estrogen levels, lost our periods, and hadn’t noticed due to hormonal birth control.
The consequences of RED-S are severe. If left untreated or diagnosed too late, a patient is left susceptible to osteoporosis and potential cardiovascular issues related to poor hormonal health. I wasn’t only gambling with my athletic ambitions, but with my long-term health.
Fortunately, since I was still young enough to put down bone, I could reverse the osteopenia.
I was referred to a nutritionist. A vegan for four years due to environmental reasons, I had a restrictive diet. I couldn’t avoid the question — did veganism cause my RED-S?
According to the nutritionist, the answer was probably not. I wasn’t a vegan when my periods first disappeared and I was eating well. I increased my caloric intake and took calcium and vitamin D supplements. Eventually, I decided to eat meat, eggs and some dairy products, though transitioned away from veganism slowly. To increase intake, I had to eat when I wasn’t hungry, behavior which I had always viewed as inadvisable. My weight stayed the same as my body funneled the calories to returning to physiological normalcy, rather than to adding weight.
Changing ingrained habits or opinions is always daunting. As I paid precise attention to what I ate, I realized I was probably not objective about my diet. Though I always felt I had a good relationship with food, obviously something was not right. It took me a long time to admit this to myself.
Changing my eating habits forced me to consider the consequences for climbing.
A climber’s performance is affected by his or her strength to weight ratio. Easier and quicker than increasing strength, weight loss is a popular tactic climbers employ. Though I never tried to cut weight, I, like most, considered it a viable and normal strategy. Now, it felt like a playing card had been taken from my hand. In the context of greater concerns for my health, the strength of this frustration felt out of place and immature.
I briefly went off the pill to monitor my period. However, a month after it returned, I got a hormonal IUD. While the IUD masks my period it is also remarkably beneficial in my life. Choosing between sexual freedom, a basic right that is very important to me, or receiving cues that tell me I am healthy is a rather irritating conflict that I have given much consideration.
To decrease my susceptibility to chronic stress, another major cause of energy deficiency and an insidious tendency of mine, I tried to calm my mind via guided meditation and also socialized more. I was advised to exercise less, a catch-22 since climbing and running have always been a form of therapy for me. I compromised by stopping my habit of cycling everywhere. Otherwise, I did not reduce my exercise and climbed some of my hardest routes in the middle of treatment. However, I did become more regimented in my gym climbing; by making plans ahead of time, I sometimes avoided staying there for hours and using the gym as an emotional outlet.
After two years, I received another scan. My bone density increased; I was at 91% of normal for the spine and hips, yet at 85% for the femoral neck, meaning I still have minor osteopenia in my neck, and, as I near my 30’s, I likely always will.
I had wanted to try an IUD for a year prior to my doctor’s visit, but I put it off due to a busy schedule and lack of health insurance. Had circumstances unfolded differently, I might have walked into the gynecologist’s office in my late twenties, when reversing osteopenia is potentially impossible. While only a frightful hypothetical situation for me, finding out about RED-S too late is likely a reality for many young athletes.
Today, I always consider RED-S when I plan my diet or training. This requires discipline, as my major symptom is a silent one and my birth control effectively removes my ability to monitor my hormonal health. It can be easy to fall into cycles of stress or of believing uncomfortable notions that I am eating “too much.”
So, months after the diagnosis, I printed the initial report and put it in my climbing notebook. That paper can turn the hollow pain I felt on the first day — fearing I made a mistake I couldn’t recover from — into a physical presence I can carry within me.
Sometimes, it is roused when I stress over jobs, climbing or relationships. It reminds me that health is fragile, though easy to ignore in pursuit of other goals, even something as trivial as a climbing grade.
On good days, I realize that what is on the line is often far greater than what I might lose, or, more simply, what I might not achieve.
This article was originally written for Gnarly Nutrition. The post can be found here.
1 Nazem, Taraneh Gharib, and Kathryn E. Ackerman. “The female athlete triad.” Sports Health 4.4 (2012): 302-311.
2 Mountjoy, Margo, et al. “The IOC consensus statement: beyond the female athlete triad—Relative Energy Deficiency in Sport (RED-S).” Br J Sports Med 48.7 (2014): 491-497.
The first time I heard someone wobble I was dropping down into L’Espadelles, one of the most popular crags in one of the most legendary sport-climbing areas in the world.
The cries were shrill and prolonged, laced with expletives. It went on long enough that I was able to pinpoint the source — a recognizeable professional climber, fists pounding in the air. The image of him sinking into his harness as his anger seemingly turned to sorrow stuck with me. His sense of overwhelming defeat was palpable, as if hanging off the end of the rope —not having to deal with his own weight against gravity—was all he could do.
I thought it was embarrassing and immature. I didn’t understand why someone would have such an emotional reaction over a random piece of rock in which success was indicated by two adjacent bolts. It was spring 2013 and I was a foreign exchange student living in Barcelona for a year. A 5.11 climber, I was just beginning to get comfortable taking lead falls and certainly hadn’t tried a route more than once or twice.
I was absolutely ga-ga over this new sport, and, naively, couldn’t understand how someone could derive so much anger from it.
Seven years later, I’m a different kind of climber.
My eyelids fluttered closed as I put the van in park. Still, the glowing lights of the highway pulsed in the darkness. Though I had just driven for fifteen hours straight, I did not feel tired. The smell of the night’s rain lingered gently, weaving its way through my window. For a minute, though I was alone, I felt the warmth of intimacy curling up into my spine. Sleep came quickly and I awoke slowly, the hum of traffic on Rainier reminding me where I was. I lit the stove and soon the sound of cars was broken with the welcome slow gurgle of a finished pot of coffee. Today, I noticed the shape of the mug, its heat emanating into my hands.
The only time in which I find total clarity is when I am running. It’s often very brief, a few minutes here and there, but it is distinctive and real. I suppose the simplicity of the action is freeing, it’s almost like breathing- you just do it.
In October and November, I had been running on the Yosemite Valley loop trail. Every time, I ran the same length of trail which passed directly underneath a classic, steep and short route called Cosmic Debris. You can see the short angled crack jut between the pines, daring you to come try it . I had been working on the route for several days. Normally, when I’m projecting a route, I tend to find myself visualizing it when I run.
In fact, for Cosmic Debris, I’d always deliberately look at the route when I ran, to try to force my mind onto it. Because this time, and for many runs prior to and after this one, I was elsewhere, I was somewhere I really didn’t want to think about. My feet were touching ground with Yosemite Valley, but in my head I was in a vivid fantasy, performing the eight moves of the finishing crux to a route I had worked on over the summer. I could feel the left smear under my left foot, could almost see the Californian sun get a little dimmer as I found myself in a dark, wet, small cave in northwestern Washington. Physically, I was in a climbing mecca, a gorgeous spot many people vie to be in, even if only for a few days. It honestly feels embarrassing to admit this, like I am pining for some long lost lover.
That’s why you’re good”. “The best , they always try to push through the pain. They have to.”
My right hand was warm, covered in clear ultrasound gel. A probe was pressed against the base of my right ring finger, the same place that had been achy for two weeks. A computer monitor to my right displayed a coarse black and white image. In the center was a thick line made up of different shades of gray. It reminded me of a river. Below the line was a large black gap, and then a bright white base. The gray river was my tendon. Normally, it sits flush against the white line, the bone. My tendon was held well above the bone- 40cm at minimal resistance- because I had torn the ligament, the pulley, that holds it there.
For one last moment, the place we’d left that evening materialized in front of me. Evanescent, like a thin dawn haze you’re not sure exists, and yet so solid that you’ve spent months here. It is secret and mysterious, radiantly verdant and bursting out of the forest, daring and breathtaking.
When climbing clicks it’s as good as any buzz out there. It is fierce and lithe- a cheetah taut, tight, and then leaping at full stretch. It’s as precise and right as an iris flower, beautifully optimized to perform. It is momentous and captivating, the beginning score of a flawlessly tuned orchestra rising suddenly from silence, deep, full and roaring inside of you. You’ll go through a million bad days for those minutes of absolute perfection.
That feeling brushed by me last weekend, like a soft wind soothed by the mountains. A mere thirteen body movements at the cusp of my limit, executed perfectly. I chased it down the rest of the day, but as quickly as it came it was gone.
More often than not, the big cat is turned nervous and edgy. The flower opens too soon, a jagged out of tune note thunders out of harmony, the volume turned up full blast. It’s a thin line to walk- achieving the most meaningful flow requires a no-guarantee investment of many, many bad days.
Climbing near my limit forces me to prove it to myself. Can’t be weak and try voodoo. Can’t be unfocused and try voodoo. Maybe I can’t love you and try voodoo. Can’t give anything less than a furious, firey, ball of energy. A calculated, controlled explosion of emotion, power, fight, strength, and humility.
It was the kind of day where you could so easily slip into the weather, let it take you by the hand and guide your mood.
“No…”, I managed to mutter.
My breath quivered and hung in the air, a sliver of silver. I watched it rise, coalesce and crash into itself, tumble outward and grow until it vanished, a slim shadow thickening into the gray sky.
He was right. I was frustrated and doing a poor job of hiding it. I had tried a route, “Third Millennium” that I deliberately sought out because I hoped it would be challenging. The most difficult series of movement on the route is the very first dozen or so moves. On my first attempt I tried the sequences repeatedly, but did not even come close to doing any of them. I pulled on the rope, slumped deep in my harness and looked up. I saw seven quickdraws, slapping and shuddering in the wind. This is when I felt my mind split into two.
One part of me was highly motivated by the challenge. This level of physical difficulty in climbing is what I had been looking for over the past few months. I wanted to clench the route and crack it open, light it up, examine it deeply from all angles until I found a way. I felt unfrightened, curious, driven, and eager. I wanted to continue up the climb.
The other part of me was angry and sullen. It told me I was weak, a bad rock climber, not cut out for routes of this difficulty. I felt stressed, inadequate, disappointed, sad. I felt like I was expected to give up.
I had to make a decision to keep climbing or to stop.
I belayed two other climbers who made easy work of the route. I was speeding down the mental pathway I chose, a bottomless flood rising behind me with no way to get back once crossed.
I was not always like this. Sometime in the past few years, I have forgotten how to ignore this insidious blackout. Now I run into it, arms wide open.
I did return to the route the following day, and thanks to considerate, careful, and kind support from my partner, managed to figure out the moves. A dozen or so working attempts later, I finished the route. Despite my consistent progress, I was still chained up, a prisoner living inside myself.
In the hour after I sent, I was struck by a memory, sweeping and strong in its clarity. In 2015, I signed up to run a half-marathon a mere two weeks before the race. I had just gone through a tumultuous break up with someone I loved and who loved me. I had not ran that distance in a long time, but somehow, I felt the race would help me heal.
I remember my foot jolting against the pavement on my first stride. I saw his face, stricken and cold. I saw the dull glow of my bedroom light. I felt the blades of grass tickling my cheek as I leaned in, charged and warm with desire. I heard the clicking of my bicycle chain, the wind blunt against me.
The air smashed into my ribs and my legs screamed, but it did not hurt. Nothing could hurt. I got second place in that race, beating some semi-professional runners and blew past my own personal record.
I knew then that I have a unique energy. It can transform me, send a shock of electricity that leaves me crackling and glowing. I am capable of more than I think, physically, mentally, emotionally, if I just let myself try.
Of course, I am entirely aggrandizing certain chronic habits and ideas. I’ve always liked to write, but lately I have been indulging on an almost gluttonous level.
With tired red eyes I shift an unfocused gaze toward the metro window, comforted by the regular intervals of dazzling horizontal sheets that leap from the darkness. My mind feels slippery, grasping for solid ground and finding nothing. I only have a few moments to gain purchase, otherwise I’ll be in free fall.
I close my eyes; everything is dark but I can almost make out deliberate ripples in the shadow. Thoughts doing their ritual dance, unfurling and folding in on themselves. Everything clenches tight- I know how sharp it can slice.
I’ve been around the real thing enough- remarkable people, smart, beautiful, strong, acutely aware of their desires and potential. I’m good enough to spot the difference when it’s right in front of me. For one sublime, breath-robbing moment I think of you.
I open my eyes and get off the train. Riding the stairs out of the underground, met by an unrelenting, vivid light.
It started like a brief whisper in the wind, a tingling, imperceptible brush against your cheek, not even enough to make a leaf flutter. Now it’s howling and snapping in every direction, so chaotic and strong it rips you apart, no matter how tightly you try to hold it all at your chest.
My demons emerge and they tell me to be afraid. Be afraid you’re not smart. Be afraid you’re not attractive. Be afraid of your body. Be afraid of being alone. Be afraid of commitment. Be petrified of embodying every kind of flaw there is. Put yourself in the line of fire and don’t you dare move. Good girl.
In my early 20’s, I somehow managed to ignore it. This was a light time- radiant summer days, late nights dancing with boys, afternoons at the library trying to suppress bursts of laughter with genuine friends, early mornings relishing your strong stride on a run. Any decision felt reversible, unimportant.
Now, the fear wants to be indelible, to burrow into your bones and become indestructible. To paralyze you, so you’re always miserable. So you’re always tired. So you never know what is actually important to you. So you’re always on the verge of believing, until you finally lose yourself and give in.
At first it is borne externally, but eventually it is engendered in your own self. You start to believe it. You can’t follow the thread of each thought to its source before you hit a tight mess of knots. You become callous and bitter and cold towards others because you are trained to question everything , especially your own thoughts.
It seems, though, that there is one sacred, pure though that is uncorrupted and unable to be manipulated- my ambition to be the best climber I can be in a way that I have defined. It is the one thing that makes sense. Finding this natural outlet to direct my drive, which has brought fleeting moments of rich and deep satisfaction- moments when the fear is absent- comes hand in hand with drawn out periods of sometimes agonizing despair when I can’t align my life with my goal. It’s during these times that I most easily give into my demons. I cannot decide if it is a gift, or it is a curse. I’m certainly aware that the pressure of climbing well creates its own unique fear.
It’s interesting how a mere circumstance- me walking into the climbing gym at my undergraduate university and wanting to flirt with one of the climbers- eventually connected two disjoint parts of my brain, like lightning striking the earth. I think I’ve been trying to hold onto old priorities, as a means of protecting myself from the strike, but lately I’ve wanted to strip it off, envelop myself in the bright sheet of light, the jagged shards of static, carry the wounds with me.
Understanding the darker sides of my ambition does not remove the numbness. It doesn’t take away the need.
I can either ricochet between what I want to do and what I feel like I should do, be introspective and unsatisfied, or, take a deep breath and a big chance.