Hit by energy deficiency condition, S’pore triathlete Louisa Middleditch powers on

SINGAPORE – Just weeks before the SEA Games, national triathlete Louisa Middleditch should have been in peak condition, but instead found herself struggling to get out of bed for training sessions on some mornings, despite clocking in 10 hours of sleep and three-hour naps.

Fatigue, moodiness and a lack of motivation – as well as an irregular menstruation cycle – suggested that something had gone awry. While the 25-year-old noted that it was normal for triathletes to feel this way due to their rigorous training load, this time the symptoms pushed her to seek medical attention.

While doctors in Singapore were unable to reach a proper diagnosis, practitioners in Perth – where she is pursuing her PhD in sports science – were able to pinpoint the problem.

She was eventually diagnosed with Relative Energy Deficiency in Sport (RED-S), a syndrome which happens when the body does not get enough fuel and energy to meet the demands placed on it by the amount of exercise. This leads to poor health and declining athletic performance.

While it was comforting to finally understand what was going on, Middleditch acknowledged that she was also “stressing about not getting the training in”.

She said: “Looking back, I can see why I got into that state. Perhaps in the last five to six years, there was some unintentional under-fuelling, overtraining at times, or a lot of volume that wasn’t matching the required recovery or nutrition.”

She has since taken a holistic approach to manage her condition by looking at factors such as nutrition, the psychological aspects of competition, and her high training volume. She is now more flexible with her training volume, taking it day by day instead of following a strict routine.

She added: “We scrapped everything that was on the plan. It was more of waking up and seeing how I felt, since for weeks I couldn’t even fathom getting out of bed and going to training. I was sleeping like 10 hours a night and having three-hour naps in the day, but I was still constantly drained, emotionally and physically.

“Ultimately, you need to take a step back to rest and then go again, and you’ll come back stronger.”

The strategy paid off at the December SEA Games in Thailand, where she won a silver in the women’s duathlon team relay and bronzes in the women’s aquathlon team relay and mixed duathlon team relay.

Her coach Matt Bury noted that “experienced athletes like Louisa know their bodies well, and they also know the requirements of the race they are targeting regarding training load”.

With her diagnosis coming late in October, he had to adopt unconventional methods to get the best out of her during training sessions – sometimes even forgoing training sessions based on how she felt physically.

He added: “We had to take feedback from our medical team on training load (volume and intensity), if it was not altered to be within the zone of Louisa’s fuel intake, we would run the risk of stress fractures and indeed see her unable to function as an athlete in any capacity.

“Those who know Louisa well, know she is truly a focused and professional athlete. Resilience, accountability and determination are traits that we see in her daily.”

Despite having to train and compete through RED-S, Middleditch has no plans to quit the sport. The seasoned athlete, who won a bronze in the individual triathlon at the 2023 SEA Games, has also competed at the Asian and world championships, as well as the Hangzhou Asian Games in 2023.

“I love it, and it’s my life, but I am also conscious that I can’t carry on like how I was previously. I’m in a much, much better place now,” she added.

For the 2026 season, she plans to shift her focus to cycling and competing in stage races and individual time trials. The move will help to ease the strain on her body from RED-S and other injuries – she has suffered a few stress fractures as the condition causes low bone density.

She is also targeting a second outing at the Asian Games, which is scheduled to take place from Sept 19 to Oct 4 in Aichi-Nagoya, Japan, stressing that “we’re playing the long game, we’ll just take it as it comes”.