Renee McGregor is a sports and eating disorders dietitian and author who works with elite athletes, Olympians and Paralympians. A specialist in eating disorders, earlier this year Renee co-founded #TRAINBRAVE with athlete Tom Fairbrother to raise awareness of ED in sport, address the culture that contributes to it and encourage openness.

An accomplished ultra-runner herself, Renee is a two-time finisher of the seven-day Manaslu trail race (220km through the Himalayas) and has completed, amongst many other ultras, the Gower 50 ultramarathon. We cover this, #TRAINBRAVE and more in this Q&A.

Tell us about your job as a performance and clinical dietitian – what does a typical day involve?
Every day is really different; it varies from clinic with athletes wanting to optimise their performance, to those who have developed difficult relationships with food and training. Or I can be working with a specific team such as Scottish Gymnastics or the Great Britain 24-hour running team; similarly I could be doing workshops or lecturing on MSc sports nutrition courses. I also try and spend one day a week writing as I contribute to a number of publications including Tri 220, Run ultra and Delicious magazine. More recently, I have also been advising on mental health panels and campaigns.

What prompted you to set up #TRAINBRAVE?
I’ve worked in high performance sport since 2010, and before this I worked as a clinical dietitian in the NHS where one of my specialist areas was eating disorders. So while I moved to work in sport as I thought it would remove me from clinical work, what I found was that my clinical background was actually very beneficial in the area of sports, particularly because of the high prevalence of eating disorders (ED) but also in the field of Paralympic sport.

In 2017 I wrote the book Orthorexia (about excluding foods in pursuit of a ‘clean’ or ideal diet) and on the back of that was asked to talk on a number of podcasts. It was on one of these podcasts that Tom Fairbrother heard me speak; apparently everything I said on this podcast resonated with him as he had recently written about his own experience and journey of an ED. So I guess you could say that TRAINBRAVE is the collaboration of two individuals equally passionate about raising awareness of eating disorders and wanting to change the culture in sport, because of their professional and personal experience.

Do you see athletes of all levels struggling with disordered eating or is a particular group more susceptible?
This is quite a difficult question for me to answer as I guess it has become my specialist area and 90 percent of the individuals I work with are athletes, recreational, professional and elite level, with difficult relationships with food, so I guess my answer would be a bit biased. In general I’m seeing it across all sports – endurance, body building, team [sports], gymnastics – while in the past I think it was associated with those sports that were seen as aesthetic or weight dependant.

RED-s (relative energy deficiency in sport) is being talked about a lot in relation to under-fuelling – can you explain what it is?
RED-s is a collection of symptoms associated with low energy availability. This basically means that the energy being taken into the body and available [for use] is not sufficient to maintain biological processes as well as physical activity. The body always prioritises movement and so when there is low energy availability it compensates by going into energy preservation mode and thus it dials down many of the biological processes in the body such as the reproductive system, digestive, immunity, cardiovascular and growth and development in young athletes.

RED-s can be involuntary; that is the individual is just not aware of how much energy is required for the training they are doing, including everyday activities such as commuting to work on top of their training. Voluntary RED-s is a more psychological driven condition where the individual chooses to make a change to their diet, training load and body composition as a direct response to wanting to improve their performance. But what starts out completely innocently can soon turn into a complex set of physical and psychological consequences.

In my opinion, RED-s is actually probably more of a risk in the everyday runner or cyclist as not only are they combining training with work – and probably life – they rarely have the support teams of dieticians, medics, psychologists around them that elite sports people have, who can monitor their training load and energy intake.

What are the warning signs of RED-s and what should people do if they think they have it?
It can be a mixture of physiological, behavioural, psychological and performance-related symptoms, which for women can include a lack of three consecutive periods, anxiety, poor sleep patterns, preoccupation with food and over-training or difficulty taking rest days. You can read the full list here. If someone believes they could have RED-s it’s important they seek professional support.

You’re an ultra-runner yourself. How long have you been running?
I started running in 2005, initially just short runs, 10 minutes out and 10 minutes back. I slowly built up and did my first half marathon a year later. I continued to build my distance over the proceeding years; I did three marathons all in the same time of 3.17 and several ultras. In 2015 I was diagnosed with Sarcoidosis which is an autoimmune lung condition which meant for the next few years I had to reduce my training significantly. It has only really been since April 2018 that I have slowly built my running up again while being very mindful of my symptoms. I’ve thrown my watch out and now just focus on choosing races that also offer me an adventure.

Last time we spoke you’d just run the 220km Manaslu Trail race in Nepal for the second time. What is it about the race that made you return to do it again?
I absolutely love Nepal and love this race. There is something about the Himalayas that makes you feel completely at peace with yourself. I first experienced the Himalayas when I was 17-years-old and immediately knew that I had to spend more time in the mountains as they energise, restore and generate strength within me.

I separated from my husband of 14 years in September 2016; while I couldn’t manage it immediately, I promised myself that once I had managed to get myself back on track I would return to the race that, first time round, helped me to believe in myself and my resilience. I booked my trip Christmas day 2017, 11 months ahead of actually going back.

How did your experience this time differ to when you did it five years ago?
I loved going back and to a degree I went back a slightly different person. When I initially went in 2013, I was probably still competitive and wanting to achieve a good performance. While I had the most amazing experience, I definitely missed out on what else this race had to offer. This time round, I went with the sole intention that it was going to be a journey for me. I wanted the mountains to do the job they do so well and also just meet some like-minded people. Both experiences were eye openers – this race is tough but equally both gave me so much, from new friendships to a deep sense of belief that I am enough just as I am.

As you’re a performance dietitian your fuelling must have been pretty on-point. What was your strategy and what did you eat?
I do try and practise what I preach but the thing about sports nutrition, or any nutrition really, is that theory does not always translate into practise for every single person, so you have to adapt your advice on an individual-by-individual basis. I spent summer 2018 in the Alps working on training camps and training for Manaslu so I was pretty confident about what food works for me in the mountains. So for me a mixture of sweet and savoury; oatcakes, Snickers bars and peanut M&Ms worked brilliantly.

Which has been your most challenging run to date?
This is a really difficult one. I guess Manaslu is really challenging because of the severe cold temperatures, the basic living accommodations and the altitude, but equally, it’s what makes this race so appealing to me. I’m happiest when I’m completely stripped back and have everything I need in a small bag. The other one that springs to mind is the Gower50. I did this in October 2014 and it was 50 miles around the Gower peninsula over sand dunes, coastal paths and also on cycle tracks. The constant changing terrain made it very difficult to get into any sort of rhythm, but again a really amazing experience.

Most ultra-distance runners have some tricks up their sleeves for tough moments. What works for you?
For me I just try to remind myself to be grateful – it wasn’t so long ago that I wasn’t sure if I would ever run, let alone be able to race in beautiful locations anymore so I just think about everything I do have. I remind myself that I have picked myself up off the floor so many times in my life and so how I’m feeling right now will pass.

Are there any endurance sport bugbears or myths you’d like to dispel?
I am really anti-‘low carb, high fat’ for endurance sport; I’ve seen so many careers end because people have followed this path and it has led to hormonal imbalances and long-term health consequences. It seems everyone wants to be come ‘fat adapted’ but to be honest if you do endurance training, you are always burning fat and carbs for fuel and the more you do this, the more efficient you become at using fat for fuel.

What are your favourite items of kit for racing and training?
I have to say I love my UD (Ultimate Direction) backpack and I also really love the VJ IRock 2 trainers – a friend of mine from Norway sent them to me for Manaslu specifically, and they are the best shoe I’ve ever had – I have never been so confident in pair of trainers and so my downhill running has improved significantly. It’s still shocking, but way better than before!

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What’s on the horizon for you for the rest of 2019?
So this year I have a lot of exciting work projects – I have just launched EN:SPIRE, the first ever sports-specific ED (eating disorder) recovery clinic in the UK, so watch this space, but also to mark the first year Anniversary of TRAINBRAVE we are going to have a conference for health professionals, coaches and medics.

From a running perspective, I’m off to Latvia to run a 35K race through the forest; I’m signed up for a half-marathon in Brecon in May; and I will spend the majority of the summer working on training camps in the mountains of Europe before I tackle the 4-day stage race of the Ultra Tour Monte Rosa (170km with 11300m of ascent).

You can follow Renee on social media via www.instagram.com/r_mcgregor and www.twitter.com/mcgregor_renee or you can visit Renee’s website: www.reneemcgregor.com.

To find out more about TRAINBRAVE visit www.trainbrave.org.