Relative Energy Deficiency In Sport (RED-S): Risks & Prevention

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Relative Energy Deficiency in Sport (RED-S) is a syndrome of impaired physiological function, including metabolic rate, menstrual function, bone health, immunity, protein synthesis, and cardiovascular health, caused by relative energy deficiency (energy intake less than energy expenditure). This condition can affect athletes of all levels and in any sport, but it is most commonly seen in endurance sports, weight-class sports, and aesthetic sports.

Understanding RED-S

RED-S is more than just the Female Athlete Triad. While the Triad focuses on the interrelationship between energy availability, menstrual function, and bone mineral density in female athletes, RED-S expands this concept to include male athletes and a broader range of health and performance outcomes. It recognizes that insufficient energy intake relative to energy expenditure can have wide-ranging negative effects on an athlete's health and athletic performance.

Causes of RED-S

RED-S is primarily caused by an imbalance between energy intake and energy expenditure. This can be due to several factors, including:

  • Inadequate caloric intake: Athletes may not be consuming enough calories to meet their energy needs, especially during periods of intense training.
  • Excessive energy expenditure: High training volumes and intensities can significantly increase energy expenditure, making it difficult to maintain energy balance.
  • Disordered eating: Athletes with disordered eating patterns or eating disorders are at a higher risk of developing RED-S.
  • Intentional or unintentional undereating: Some athletes may intentionally restrict their calorie intake in an attempt to lose weight or improve performance, while others may unintentionally undereat due to poor meal planning or lack of nutritional knowledge.

Health Consequences

The health consequences of RED-S can be serious and long-lasting. Some of the potential health problems associated with RED-S include:

  • Decreased bone mineral density: This can increase the risk of stress fractures and osteoporosis.
  • Menstrual disturbances: Female athletes may experience irregular periods or amenorrhea (absence of menstruation).
  • Impaired immune function: This can increase the risk of illness and infection.
  • Cardiovascular problems: RED-S can lead to heart problems, such as arrhythmias and sudden cardiac death.
  • Gastrointestinal issues: Symptoms like bloating, constipation, and diarrhea may arise.
  • Psychological problems: Athletes may experience depression, anxiety, and low self-esteem.

Impact on Athletic Performance

In addition to the health consequences, RED-S can also negatively impact athletic performance. Some of the potential performance decrements associated with RED-S include:

  • Decreased endurance: Athletes may fatigue more easily and have a reduced capacity for sustained exercise.
  • Reduced muscle strength and power: RED-S can lead to a loss of muscle mass and strength.
  • Impaired coordination: Balance and agility can be negatively affected.
  • Decreased training response: Athletes may not respond as well to training and may not see the expected improvements in performance.
  • Increased risk of injury: Weakened bones and muscles can increase the risk of injuries.

Prevention and Treatment

Preventing and treating RED-S requires a multidisciplinary approach involving athletes, coaches, parents, and healthcare professionals. Some of the key strategies for preventing and treating RED-S include:

  • Education: Athletes, coaches, and parents need to be educated about the risks of RED-S and the importance of maintaining energy balance.
  • Nutritional counseling: Athletes should work with a registered dietitian to develop an individualized nutrition plan that meets their energy needs.
  • Monitoring: Athletes should be regularly monitored for signs and symptoms of RED-S.
  • Treatment of underlying eating disorders: If an athlete has an eating disorder, it needs to be treated by a qualified mental health professional.
  • Gradual increase in energy intake: Athletes with RED-S need to gradually increase their energy intake to restore energy balance.
  • Reduction in training load: In some cases, it may be necessary to reduce training load to allow the body to recover.

Call to Action

If you are an athlete, coach, or parent, it is important to be aware of the risks of RED-S and to take steps to prevent it. By working together, we can help athletes stay healthy and perform at their best. If you suspect you or someone you know may have RED-S, seek help from a healthcare professional experienced in sports medicine and nutrition.