Welsh triathlete Issy Morris may only be in the early stages of her career, but she has already overcome far more than most.
At the Birmingham Commonwealth Games she secured an impressive 19th place in the women’s triathlon race, a promising achievement from afar. But when you dig deeper into what the 23-year-old has gone through, the fact she was even on the start line is a miracle in itself.
In 2020, after changing her form of contraception, it was discovered that Morris was suffering from Relative Energy Deficiency in Sport - also known as RED-S - as well as osteopenia; low bone density. It was the outcome of her 20-hour-a-week training schedule but, unknown to Morris at the time, her lack of nutrition as well as her contraception was doing untold damage to her body.
RED-S can have serious and occasionally fatal effects on metabolism, menstrual function, bone health, immunity as well as cardiovascular and psychological health. British runner Bobby Clay is another promising athlete who has endured the brutal impact the condition can bring, after being diagnosed with osteoporosis at just 18 years of age due to overtraining and under-eating. It’s a story Morris can more than resonate with.
While appearing fit and healthy, and performing in races better than ever, secretly Morris’ body was suffering beyond belief. But it was a change in her contraception back in March 2020, and the failure of her periods to resume, that prompted her shattering diagnosis.
“Leading up to it [the diagnosis], performance wise I was doing the best I’d ever done,” Morris told Mirror Sport. “I ran a PB on the track for 5k, so I did like 16:23. Training was going really well and I was looking forward to the season beginning.
“At the same time, in myself, I guess there was nothing I really noticed at the time. I was tired a lot of the time but as an athlete, you are. You tend to be quite tired a lot of the time. In terms of warning signs I literally didn’t have any.
“Covid was beginning and I was, at the same time, getting more interested in nutrition and listening to podcasts on athlete health. I was finding out how important it is to have a period as an athlete. I knew that by being on the implant [one in three people stop getting their period altogether after a year on the implant] for me that was the case.
“I didn’t have a period but I knew that was normal due to the contraceptive but I wanted to get the contraceptive removed to make sure my body was healthy. I got an appointment with a specialist gynaecologist to get it removed and I asked how long it would take for my period to come back. He just said, ‘oh well if you’re an athlete it probably won’t come back’.
“For me I just thought that’s so wrong. It just ignited the fire even more that things need to change.”
"That was a huge shock for me"
The fire within had been ignited even before Morris knew the true extent of what was happening to her body. Unbeknownst to her the contraceptive implant, which works by chemically suppressing hormones to prevent pregnancy, may also have prevented any indication she was fighting an energy deficiency condition.
Six months after having her implant removed Morris was still waiting for her period to return but, while waiting, she continued to train more and more. By that time the country was in full lockdown and there wasn’t much else to do other than train relentlessly.
In a quest for answers the Cardiff-based athlete sought out Dr Nicky Keay, a renowned sports endocrinologist. After being referred for a scan in September, her diagnosis of the deficiency and her osteopenia came to light.
“That was a huge shock for me that my bones were not in a good way,” Morris said. “I think because there was nothing you could see really - I was thin as an athlete but I wouldn’t say I was too thin.
“There weren't any proper external warning signs you could see, which is why I was worrying that the inside of my body was suffering so badly.”
"It was one of the toughest years I've had to go through"
Following the devastating diagnosis, Morris was told to stop exercising completely and that she had to gain weight. In the end she spent a whole year out of action, unable to do anything and it was a full year until her period eventually returned.
Understandably it was emotionally challenging for Morris to go through. All those dreams and ambitions young athletes harbour to represent their countries on the biggest stage was having to take a back seat while her body could get back into a healthier state.
But arguably the biggest challenge of all was that RED-S is so hidden - Morris didn’t physically feel anything - and the mental battle of having to hold herself back while getting the right nutrition and fuel was immense.
“It was one of the toughest years I’ve had to go through,” she explained. “Not doing anything, especially because, as much as the bones were a massive incentive, I need to improve this. But not having a broken leg that physically stops me from exercising was really tough.”
After working with another doctor she was eventually able to return to sport in October 2021, all while maintaining her nutrition intake. She was also put onto a different form of contraception with natural oestrogen to protect her bones at the same time.
But even more remarkably, that return to sport was the beginning of her journey that saw her represent Wales at the Commonwealth Games, as well as securing a place at the European Championships. Despite all the odds Morris achieved what she wanted, but her experience has undoubtedly taught her so much about herself and life.
“It gave me a new perspective,” she said. “Before I was very much trapped in a mindset and took it all really seriously whereas I think now, having come back to the sport, I have an all new perspective.
“It’s not my life any more, I still train just as hard but I kind of know there’s more to life and I was able to see that in the year that I had out. But, at the same time, the year that I had out when the world started opening up, it didn’t feel like it did for me.
“Watching all my squad go back and train together, and not being able to join, was really difficult.”
“It was a constant battle with medical professionals through no fault of their own"
Above all else, Morris is now determined to send a warning to other athletes about the potential risks RED-S can have without the right care and attention. The 23-year-old is now also doing a masters in nutrition, and her experience has highlighted just how low the awareness levels are.
Every step of her journey was compounded by the fact that RED-S is only really detected by those who are trained in clinical sports science - relatively speaking there is little awareness among GPs.
“That was the issue throughout this whole process,” she explained. “I knew I couldn’t see my GP because I’d go and get an appointment and I’d sit down and say I’ve got Relative Energy Deficiency and they’d say, ‘what’s that?’
“You’re physically sitting down and explaining to the doctor what your condition is and it’s a role reversal that’s completely wrong. Then I’d get referred to specialists in the NHS and I’d have the same situation again where I’m getting blood taken, which I need to be able to monitor my hormones.
“I’m again having to explain what RED-S is and I’m being told by doctors to go on the contraceptive pill, which is going to put me back into the same situation.
“It was a constant battle with medical professionals through no fault of their own, it’s just not taught and not widely known. That’s what incentivised me to get the word out and I think it’s something that could easily be prevented but, when it’s not, it can cause serious damage.”
