RED-S

Relative Energy Deficiency in Sport

Do you have to ‘make weight’ for your sport? Are you in a very physically demanding job? Have you increased your training load? If so, you need to be aware of the risks associated with “Relative Energy Deficiency in Sport” (‘RED-“S” or “REDS”).

What is RED-S?

You might be familiar with the term ‘the female athlete triad’, which is a classification system used to identify female athletes who suffer from athletic amenorrhoea (loss of their monthly period), osteoporosis (weaker bones) and eating disorders.

In 2014 the female athlete triad was ‘upgraded’ to RED-S to recognise the fact that both males and females, young and old are affected by it. Furthermore, it identified widespread and long-term health effects and a reduction in performance in those affected by RED-S.

The basic principle of RED-S is low energy availability. In other words, an athlete is not consuming enough energy through their diet to sustain their training load as well as day-to-day living.

 Just to ‘be’ requires energy and fuel. The athlete’s normal physiological processes such as bone health, hormone production, reproductive health and the immune system get placed on the ‘less important’ list as the athlete’s body is essentially in starvation mode.

Why would their body use energy to maintain their ability to reproduce if there is not enough food going around?

RED-S is defined as: “impaired physiological functioning caused by relative energy deficiency and includes, but is not limited to, impairments of metabolic rate, menstrual function, bone health, immunity, protein synthesis and cardiovascular health”

Sporting codes that have a high prevalence of RED-S include running, triathlon, cycling and dancing. In the past, it was favourable to lose weight in order to ‘go faster’, ‘jump higher’, be easier in ‘point’ if you were lighter. Unfortunately, the long term health effects of a sustained energy deficit are becoming more and more apparent in recent years.

RED-S is a continuum from mild, moderate to severe. Therefore, the earlier it is addressed, the better.

Common signs that you might be suffering from low energy:

Have you noticed a declined in performance? Are you unable to sustain high-intensity efforts like you used to? Taking longer to recover after training? Waking up tired in the morning? Suffering from body soreness?

Females – have you had any changes with your monthly cycle, especially if you have not had your period for six months or more? Males – have you noticed a decline in your sex-drive?

Have you had reoccurring colds, coughs or upper respiratory tract infections? Have you suffered from stress fractures in the past? Have you been diagnosed with low iron?

Are you relatively strict with what you should or should not eat? How do you feel if you miss a training session (anxious/angry or frustrated, or do you accept your circumstances)?

It is essential to identify low energy availability as soon as possible to minimise the impact on your health and performance.

 As an athlete, you might not be too concerned about your immune status or your ability to reproduce. What if I told you that RED-S has a significant impact on your ability to perform at your best, that it could be the one thing that is holding you back?

Performance consequences of RED-S

• Decreased muscle strength

• Decreased endurance performance

• Increased injury risk

• Decreased training response

• Impaired judgement

• Reduced coordination

• Reduced concentration

• Irritability

• Depression

• Depleted glycogen stores

If the above does not motivate you to seek treatment to improve your athletic ability, then I am not sure what will!

How do we treat an athlete who’s suffering from RED-S?

The treatment of RED-S requires an interdisciplinary team approach. Often a sports medicine doctor, dietitian, physiotherapist and psychologist are involved in getting the best outcome for the individual.

It is crucial to regain the balance between the athlete’s ‘energy in and energy out’; to restore their morning energy levels, regain regular menstrual cycles (females), return homeostasis to oestrogen and testosterone levels, alongside a graduated return to exercise.

Sounds simple right?

Please note – the oral contraceptive pill is NOT the answer to restore the athlete’s period.

If you would like further information, please do not hesitate to talk to one of the physiotherapists here at Reload Physio or do further reading. The following links offer great insight to both athletes, parents and coaches: