RED-S: Understanding the Impact on Athletes
What is Relative Energy Deficiency in Sport (RED-S)?
Put simply, RED-S is about energy imbalance. Expenditure of energy (i.e., exercise/movement) requires sufficient input (food/drink) to work effectively. The imbalance occurs when the expenditure of energy outpaces the input, causing a state of energy deficiency.
With insufficient energy intake, the body begins to prioritise functions for survival. The other functions, such as the production of hormones, bone health and the immune system begin to be lowered in priority of resource allocation.
RED-S can affect all members of the athletic population irrespective of age. Symptoms vary between individual, making the diagnosis of RED-S more difficult. Classical symptoms include fatigue, recurrent injuries, prolonged recovery time, irregular menstrual cycles in female athletes, decreased performance, and psychological distress or depression. Additional symptoms include:
Recurrent illnesses.
Drop in growth or an arrest in puberty for young athletes.
Bone stress fractures/injuries.
Disruptions to sleep patterns.
The key to optimising energy performance is ensuring adequate rest breaks and sufficient nutritional intake between bouts of exercise. This is referred to as ‘integrated periodisation’ and is not just about eating enough, but allowing time for the body to recover to meet the energy demands of the sport.
It’s not just about rest breaks, it’s about knowing where energy is being spent. There are instances where low energy availability can be unintentional such as an increase in training load in preparation for an upcoming event or exercise outside of training such as running to training sessions. In contrast, there can be instances of it being a product of an intentional strategy to maintain body weight or for aesthetic purposes. Though either of these cases may not be felt immediately, small deficits accumulate over time and can become long term energy deficits.
“I’ve been feeling quite a few of these symptoms. Does this mean I have RED-S?”
Not necessarily, as the symptoms themselves are not diagnostic of RED-S. RED-S is a diagnosis of exclusion, meaning that all other treatable conditions are to be ruled out through blood tests first, as they are more likely to occur in athletes.
RED-S Management
As it is a complex condition, RED-S requires the input from multiple parties. An athlete with a diagnosis of RED-S will be involved with a Multi-Disciplinary Team (MDT). Members of this team include the following: A Dietician, Sports Doctor, and a mental health professional. Other parties included would be the Athlete, Coach or Teacher, and Parents.
A critical component for treatment is to ensure that a balance can be created between training, nutritional intake, and recovery sessions. By working together, the team can plan to increase the training load in an optimal fashion and ensure a safe return to play/performance.