Relative Energy Deficiency in Sport (RED-S)
If you’re starting to increase your training volume, or been in an endurance sport for some time, you may have started to hear about something called Relative Energy Deficiency in Sport (or RED-S). As the name suggests, RED-S is the resulting effects on the body when an athlete has insufficient calorie intake and/or excessive energy expenditure.
Why is it so important to monitor?
If RED-S is not discussed and managed properly between an athlete and their coach or healthcare professional, there are many negative effects that can result including, but not limited to, altering metabolic processes, reduction in bone health, injury repair, immune responses, protein synthesis, mental health and menstrual function in female athletes. Not only this, but athletes may see a reduction in their performance even though training volume is high.
For athletes in a chronic state of RED-S, the more disturbing underlying issues can be the long term health risks including fertility and bone density complications. When bone density isn’t formed properly, it can lead to bone weakness and osteoporosis. The good news is that most of the health issues seen from RED-S are completely reversible if picked up early enough.
Where did all this discussion of RED-S come from?
In the early 1990s, there was a complex disorder coined the ‘Female Athlete Triad’ by the American College of Sports Medicine. This was the interrelationship between menstrual dysfunction, low energy availability (LEA) and a reduction in bone mineral density. Interestingly, this is one of the few cases where research into female athletes was more advanced than anything done in males. A good win for the girls!
In 2014, the International Olympic Committee (IOC) published a updated consensus statement called ‘Beyond the Female Athlete Triad: Relative Energy Deficiency in Sport (RED-S)’. This statement, lead by Sports Medicine guru Margo Mountjoy stated there are much broader implications of low energy availability in training and it didn’t just affect women but all athletes. In 2018, they updated this consensus and are now trying to increase awareness in athletes, coaches and the wider sporting community.
What are the signs?
The signs of RED-S are broad and in isolation can be a result of other factors in an athlete’s life. Usually when an athlete is diagnoses with RED-S it’s after they have trained excessively until a point where they have obtained a stress fracture injury. By knowing the signs, hopefully athletes can identify RED-S before it becomes a greater impact. Signs of RED-S include:
Excessive weight loss
Irregular or ceases in menstrual cycle
Constant illness including being sick form colds and the flu
Mood changes not attributable to other factors
Iron deficiencies
Decreases in sports performance
What can you do if you suspect you or someone you know are suffering from RED-S?
Firstly, know your role. If you are a friend or coach, you don’t need to know everything about RED-S and you’re unlikely to diagnose someone at the athletics track but awareness is the first step. What you CAN do though is have that initial chat around how your friend/athlete is feeling and be an advocate for their situation. Referring them onto a trained health expert (sports dietitian) is the best thing you can do. They will work with athletes to improve energy availability through the right strategies and nutrients.
Gone are the days where training nonstop and being as light as you possibly can is a good idea for an athlete. There are plenty of cases now where athletes have been in this situation, identified it, fuelled correctly and then performed better and been overall happier with their training and racing.
Treating RED-S
Whilst working alongside a health professional may be your first and best step, there are some small treatment options you may be able to implement. In its simplest form, the concept of RED-S or low energy availability will need one of two things; either an increase in energy intake or a reduction in training load. The IOC consensus document recommends an increase in energy intake of approximately 300-600calories per day alongside addressing other potential issues such as energy distribution, dietary composition and food related stress. It is also recommended to boost calcium (1,500mg/day) and Vitamin D intake for bone health. Working with a sports dietitian around these numbers will drastically help health metrics.
Bottomline- Understanding Relative Energy Deficiency in Sport is the first step to recognising symptoms and starting conversations in the sporting realm. There are some very rough research papers showing the prevalence of RED-S can range from 14%-63% and is higher in sports which emphasise leanness and body composition. Start the conversation. It could help your own long term health and performance or someone you train with.