What does RED-S stand for?
RED-S stands for Relative Energy Deficiency in Sport. This term was coined in 2014.
The acronym describes athletes who do not eat enough to support their high energy expenditure through sport training plus life processes.
Both male and female athletes can develop RED-S.
What does energy deficiency mean?
An energy deficiency means an athlete does not consume enough calories through food or drink to support their life processes, training loads and recovery.
Basically, an imbalance exists between the energy they burn and the energy they take in.
This term is also called Low Energy Availability. In short, low energy availability means that the athlete does not have enough energy available for both training and life processes.
To continue to sustain life, the body then compensates by slowing down or eliminating some non-vital life processes. For example, heart rate slows, growth and development slows, muscle growth slows or stops, healing and repair slows, and normal hormonal function slows.
Is RED-S an eating disorder?
Actually, RED-S may or may not accompany an eating disorder. Some athletes may experience disordered eating or full blown eating disorders. However, other athletes may be undereating unintentionally and might not have any disordered behaviors.
What is the Cause of RED-S?
RED-S is caused by an imbalance between energy intake and energy expenditure in trained athletes. Simply put, these athletes consume fewer calories than they need to support their training load.
An athlete with a static training load may reduce their calorie intake below what they need. Or, an athlete may increase their training load without compensating with increased energy intake.
RED-S may be caused by an eating disorder. However, some athletes may not display disordered eating and just fail to eat enough calories.
Who is Affected by RED-S?
Actually, RED-S can affect any athletes. However, athletes who participate in sports that promote a light, lithe body like long distance running may be more prone to RED-S. RED-S also disproportionately affects weight class athletes and athletes in sports that emphasize an aesthetic ideal like dance, gymnastics and figure skating.
What are the Symptoms of RED-S?
Actually, RED-S causes many of the same symptoms for male and female athletes. However, an obvious warning sign of RED-S in female athletes is a cessation of normal menstrual periods. This makes detection easier for female athletes.
RED-S can cause fatigue, poor performance, loss of muscle mass, altered immune function, dampened sex hormones (testosterone for men and estrogen/progesterone for women) and loss of bone mineral density for both male and female athletes.
Additional symptoms of RED-S include difficulty sleeping, mood disturbances, fatigue, injury, stress fractures, poor performance and poor growth and development.
- Loss of Periods (Female)
- Low Sex Drive (Male)
- Slow Metabolism
- Osteoporosis
- Stress Fractures
- Poor Immune Health
- Cardiovascular Conditions
- Weakness
- Fatigue
- Feeling Cold
- Poor Performance
- Depression
- Anxiety
Performance Effects of RED-S
Sadly, RED-S can also reduce athletic performance.
- Reduced Strength
- Reduced Power
- Reduced Endurance
- Increased Fatigue
- Increased Susceptibility to Illness
- Reduced Concentration
- Increased Injury Rates
What is RED-S and the Female Athlete Triad?
RED-S differs from the Female Athlete Triad. The Female Athlete Triad is an outdated term that describes female athletes who under eat, experience menstrual disturbances and face bone mineral density losses or diseases of bone deterioration.
However, the Female Athlete Triad excludes male athletes with low energy availability.
RED-S reflects the reality that both male and female athletes may under eat and face many symptoms besides just losses in bone mineral density.
How is relative energy deficiency treated in sport?
Relative energy deficiency is treated by referring athletes to a team of dieticians, psychologists and sport medicine professionals.
These athletes will need to increase their daily calorie intake and/or reduce their daily training load. Once they resume a more appropriate calorie intake, they can usually return to sport with continued monitoring.
In the past, many female athletes were prescribed oral birth control pills to regulate their menstrual cycle. However, this does not fix the underlying problem of energy restriction nor does it protect the bones.
Can RED-S be prevented?
Increased awareness, prevention and detection of RED-S can go a long way towards improving health and outcomes for both male and female athletes.
Athletes should be educated on proper energy intake for sport. They should also be educated on some of the early signs that they are not taking in enough energy. Finally, female athletes of reproductive age should be asked to monitor any changes in their menstrual cycle.
Final Thoughts
RED-S is a serious yet often undetected condition in both male and female athletes. Sadly, this condition can affect both sport performance and long term health. Education, support, early detection and treatment can go a long way towards helping athletes to maintain proper energy balance for better health and performance.
