In the realm of sports and athletics, an athlete's goals typically involve achieving peak performance and surpassing personal bests. All too often, athletes adopt an "at all costs" mindset to achieve their goals, whereby they do whatever it takes to boost their performance. Now, there are countless positive qualities that athletics foster including discipline, perseverance, teamwork, and resilience. These attributes not only contribute to success on the field, court, or stage but also in life beyond sports. However, there are instances where these qualities can show up in harmful ways.
For example, expanding training hours beyond an already demanding practice schedule or strictly adhering to a "clean eating" regimen may seem well-intentioned and stemming from a place of dedication, but for many athletes this initiates a slippery slope. Whether intentional or not, many athletes engage in behaviors that are unknowingly affecting their health, all in the pursuit of improving their performance. This can lead to a pervasive yet often overlooked issue in sports called Relative Energy Deficiency in Sport, known as RED-S.
So what is RED-S?
Simply put, RED-S is the lack of energy available relative to an athlete's energy demands. In other words, when an athlete is not taking in enough energy through food to support their energy expenditure, a state of low energy availability (LEA) occurs. When the body is in this state of energy deficiency, it cannot sufficiently support the functions required by the body to maintain optimal health and performance.
RED-S encompasses a wide range of physiological health issues including decreased bone health, menstrual dysfunction, impaired immunological function, hormone disruption, and decreased metabolic rate, among others. Additionally, RED-S negatively affects athletic performance through decreased muscle strength and endurance, increased risk for injury, and psychological symptoms such as depression and irritability, to name a few.
Who does RED-S impact?
Prior to the conception of RED-S, this condition was known as the Female Athlete Triad, which encompassed low energy availability, menstrual dysfunction, and low bone mineral density. Researchers have since expanded the understanding of this syndrome into RED-S, acknowledging that low energy availability does not just affect females, but athletes of all genders and ages, across various sports and activity levels. Whether you're a professional or college athlete, a recreational enthusiast, or a young athlete in training, you could be at risk of RED-S.
Causes of RED-S
RED-S is a multi-faceted condition that can stem from different factors including:
Inadequate calorie intake: Athletes may be consciously or unconsciously restricting their intake from food in an attempt to maintain or achieve a certain body weight or physique. This tendency is especially pervasive in aesthetic sports such as gymnastics, ice skating, and dancing, but can be observed across all sports.
Excessive exercise: Similar to dietary restrictions, athletes may be consciously or unconsciously engaging in overtraining without proper recovery, exacerbating their energy deficit and perpetuating a state of low energy availability.
Psychological stress: Athletes may experience pressure to perform (whether self- imposed or from external factors), body image distress, and other life stressors which can affect their ability to eat adequately or trigger disordered eating patterns.
Environmental factors: Societal pressures (we're looking at you, diet culture), a change in living situation or support system, and social media influence all shape an athlete's mindset and behaviors.
All of these factors increase an athlete's susceptibility to developing RED-S, affecting both their health as a human and performance as an athlete.
Symptoms of RED-S
Recognizing the signs and symptoms of RED-S is crucial for prevention and early intervention. Some common telltale signs include, but are not limited to:
Persistent fatigue and low energy levels
Decline in athletic performance
Mood shifts - increased depressive symptoms, heightened anxiety, and irritability
GI distress
Increased injuries, especially stress fractures
Menstrual disturbances (loss of period or irregular period)
Impaired immune function and frequent illness
How RED-S affects an athlete's health:
How RED-S affects an athlete's performance:
Image Source: Br J Sports Med 2015;49:421–423. doi:10.1136/bjsports-2014-094559
Prevention and Treatment
The involvement of a multidisciplinary team including professionals such as a medical doctor, therapist, dietitian, coach, and athletic trainer is crucial to the prevention and treatment of RED-S. Depending on an athlete's medical stability, adjustments to training may be necessary until their health and energy levels stabilize. Through working with a dietitian, especially an eating disorder informed sports dietitian, an athlete will be able to confront and address any under-eating or disordered eating behaviors they may be experiencing. Additionally, working with a therapist to address underlying psychological stressors and foster a healthy relationship with food and body image is imperative to an athlete's health and well-being. Lastly, education and awareness about proper nutrition, adequate rest, and balanced training are essential for the prevention of RED-S.
Conclusion
RED-S is a serious, yet often overlooked condition that can have detrimental effects on an athlete's overall health and performance. It is crucial for athletes to prioritize their health and well-being, as performance can come to an abrupt halt if an athlete is not a healthy human first. Remember that the most optimal performance stems from a balanced approach to training, nutrition, and recovery and that nourished bodies are resilient bodies.
Sources:
Mountjoy M, Sundgot-Borgen J, Burke L, et al The IOC consensus statement: beyond the Female Athlete Triad—Relative Energy Deficiency in Sport (RED-S). British Journal of Sports Medicine 2014;48:491-497.
Mountjoy, M., Sundgot-Borgen, J., Burke, L., Ackerman, K. E., Blauwet, C., Constantini, N., Lebrun, C., Lundy, B., Melin, A., Meyer, N., Sherman, R., Tenforde, A. S., Torstveit, M. K., & Budgett, R. (2018). International Olympic Committee (IOC) Consensus Statement on Relative Energy Deficiency in Sport (RED-S): 2018 Update. International Journal of Sport Nutrition and Exercise Metabolism, 28( 4), 316-331.
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