AS a top athlete, who'd represented her country, distance runner Gina Paletta was used to niggling injuries.

But when a scan last year revealed a stress fracture on the talus bone in an ankle, the 28-year-old from Wrexham knew it was something far more serious.

"Obviously you often feel tired as a runner but when I found the stress fracture, it was on such a hard bone that I thought it was unusual," she says. "Usually it's an injury caused by impact and it happens to soldiers because they march, so for it to happen there it meant my bone density was really low and that's when I started looking more closely at what was happening."

Slowly it emerged that Gina was suffering from osteoporosis and Relative Energy Deficiency in Sport (Red-S) - a relatively new term for what was formerly known as female athlete triad, a condition seen in women participating in sports that emphasise leanness or low body weight.

Clinical symptoms of the condition can include disordered eating, fatigue, noticeable weight loss, increased healing time from injuries and increased incidence of bone fracture. Affected females may also struggle with low self-esteem and depression.

"It's so personal to share something like this but I feel in sport that there shouldn't be taboos about anything," says Gina, who began running as an eight-year-old, competing for Wales for the first time when she was 12.

"It's more common than people realise and when you see the rise in popularity of events like Iron Man and triathlons and running long distances, these are everyday people who then go back to work during the week, so it's not just happening to elite athletes."

Many athletes will exhibit disordered eating habits such as fasting, as well as avoiding certain types of food the athlete thinks are 'bad', such as foods containing fat, but as Gina's experience shows, by restricting their diet, the athlete may worsen their problem of low energy availability and put more stress on the body.

"Exercise and taking part in sports like running and cycling becomes an identity and if you deviate from that, people don't think they're worthy of calling themselves a runner or an athlete," continues Gina, who gained a bachelors degree in sport development before moving to Portland, Oregon in 2011, where she gained a scholarship at the University of Portland for Track and Field and Cross Country to complete a Master of Science in management communication.

"When it starts interrupting your daily life and not just your performance, that's when it starts to become a problem. I saw my performances going down and down because I wasn't fuelling possibly.

"By last year I was walking to work every day on crutches - luckily I only live a mile away and I couldn't do anything else and it was those two miles that kept me sane."

Another symptom of the syndrome is the cessation of a woman's menstrual cycle and Gina admits she has not had a period in more than eight years.

"I went to my GP in 2010 when my periods stopped and she said it was normal because I was a distance runner," she says. "I really hope these conversations help people not to take it too far - runners are obsessive but it needs to be harnessed in the right way. The main message is to change your habits because I didn't do it for so long and I'd just wish I'd known more about it."

Gina, who works as a communications officer in Cardiff and is getting married in November this year, now wants to raise awareness amongst younger athletes of the dangers of under-fuelling and over-training.

"The energy just wasn't there," she remembers. "I was running between 70 and 90 miles a week which is normal for a distance runner but I wasn't giving my body enough. The surplus has to be there but I still look at meals and think that's a lot of food for a young female but you do actually need it. I wish I'd realised that a bit sooner.

"It's important too not to be scared and seek help right away because this is your health, so go to your GP initially. GPs have their hands full but I can't praise them enough and I hope a lot more will start to become aware of Red-S."

As for her running career, Gina hopes to return to competing this year but knows she cannot rush things after her experiences of the last few years.

"I spent the entire year last year in a boot, so just running would be great," she adds. "Doing my first park run again will be an achievement, but I would like to be back running fully fairly soon. Just walking around pain free is a luxury, so I don't take anything for granted."

For more information on Red-S go to