Relative Energy Deficiency in Sports, the condition all sports people need to know about

So what is Relative Energy Deficiency in Sports (aka RED-S)?

Let’s start with a universally agreed definition:

In simple terms the athlete is consistently burning more calories than they consume resulting in a lack of energy. This comes with some very serious consequences that are discussed later in the blog.

For clarity, in this blog we refer to athletes, this is in the broadest sense of any one competing in a sport, not just the narrow definition of track and field athletes.

Ok so what do we mean by Low Energy Availability? And whilst we’re at it what’s “problematic LEA“?

Energy availability (EA) is the difference between daily Energy Intake (calories consumed) and Exercise Energy Expenditure (calories burned during exercise).

Low Energy Availability (LEA) refers to any imbalance between the energy consumed through diet and the energy expended during exercise, resulting in an insufficient supply of energy to meet the body’s overall needs. This inadequacy compromises the body’s ability to sustain optimal health and performance.

I increased my expenditure but not intake … then you get faster because you’re training more and getting slightly lighter and your brain goes “surely you can eat even less, weigh less, and get even faster.”

“I’d got self-destruction down to a fine art”: a qualitative exploration of relative energy deficiency in sport (RED-S) in endurance athletes; Langbein RK, Martin  D, Allen-Collinson  J , et al 

Problematic LEA exposure to low energy availability causes significant and possibly long-lasting disruption to different body systems.

How can it be bad for my performance if I get faster and weigh less?

An athletes initial performance might improve. However, failure to recognise problematic LEA and RED-S will inevitably cause performance and health to deteriorate. Athletes can expect to experience decreases in power performance, availability, training response, recovery, cognitive performance/skill, motivation, muscle strength, endurance.

If athletes develop low energy availability (LEA), it can lead to a Relative Energy Deficiency in Sport (RED-S) syndrome which has severe health consequences if not treated.

A lack of understanding about needing more nutrients when training more may lead to improved performance at first. But later, changes in body composition and short-term performance gains can lead to more focus on diet, exercise, and body image, to attain even better performance thus leading to restrictive eating practices.

OK, now we know what it means and that performance will suffer, what are the health risks for athletes?

The health concerns associated with longstanding LEA and RED-S include:

Fatigue
Rapid weight loss
Missed periods or delayed puberty (female athletes)
Low libido (male athletes)
Frequent illness
Hair loss
Impaired cognitive function (eg trouble focusing)
Issues with heart and blood health
Mental Health issues (eg irritability and depression)

Individually or combined these can all harm how well you feel, make it more likely for you to get hurt, and make it harder to perform well in sports.

Is this the same as the female athlete triad?

The female athlete triad is a subset of RED-S describing three interrelated conditions: disordered eating, irregular menstruation, and bone loss. It isn’t a condition of in its own right but a spectrum.

At the positive end of the spectrum, female athletes consume enough good quality calories to cover their energy needs. They have regular monthly periods, and their bone strength is as good as or better than inactive people because of their weight-bearing workouts.

One sign of not having enough energy is irregular periods in women. Basically an indication that their hormone production is affected.

At the very negative end of the spectrum, female athletes aren’t eating enough good quality calories to cover their energy needs. Because of this there can be a loss of menstrual cycle, low bone density, and osteoporosis. Athletes are at risk for fractures due to low bone density and osteoporosis.

A problem with any one aspect of the triad can be a cause for concern. If you’re a female athlete experiencing issues with any aspect of the triad seek help from your Doctor and the support of a health coach.

So, how do you prevent LEA and RED-S?

Education and awareness are fundamental to help athletes focus on maintaining a healthy energy balance. Moreover, it is crucial to work individually with athletes to support them in developing healthy eating habits. Such as consuming the right amount of nutrients, understanding when to eat, and how/when to choose appropriate supplements. In short, nutrition coaching.

The IOC identifies three athlete development stages:

*Body composition is manipulating the relative amount of fat and muscle.

The IOC consensus: body composition and dieting techniques are only for mature Elite / Professional athletes with a positive self image.

Supporting athletes to build the foundational nutrition skills and to adopt sensible fuelling strategies is essential. It is this area of coaching that Aliénor focuses on, particularly with youth athletes.

If you would like to learn more

Check out the scientific papers provided in the sources section below.

Sources

2023 International Olympic Committee’s (IOC) consensus statement on Relative Energy Deficiency in Sport (REDs), Mountjoy, Ackerman, et al, 2023

“I’d got self-destruction down to a fine art”: a qualitative exploration of relative energy deficiency in sport (RED-S) in endurance athletes; Langbein RK, Martin  D, Allen-Collinson  J , et al, 2021

Relative Energy Deficiency in Sport (RED-S): Scientific, Clinical, and Practical Implications for the Female Athlete, Cabre, et al, 2022