This week we’re talking all about RED-S. Something many of you may have never heard of. If you’ve spent time in the world of sport and athletics, you may be familiar with the female athlete triad – a combination of disordered eating, lack of menstruation, and osteoporosis. This combination is typically developed through over training with inadequate intake (FOOD!) which results in poor calcium maintenance in bone and altered hormones affecting reproductive cycles. It’s important to clarify that inadequate food intake can be both intentional and non-intentional; both because of poor eating habits and too intense exercise. RED-S has come about more recently to capture all the bodily functions affected by over-training and under-fueling; and to address the fact that males can fall into these patterns just as commonly.
Really, any active person is at risk for developing RED-S – relative energy deficiency in sport. You don’t have to be involved in competitive athletics, training, or sport; however, competitive athletes may be at a greater risk due to more rigorous training schedules. Those who participate in endurance sports, or aesthetic sports like gymnastics or dance are also at a greater risk. RED-S captures both males and females and in its most simple form occurs when an athlete consumes too few calories for their activity level.
RED-S can be difficult to diagnose because it can present in a variety of ways. A large indicator for this in females is a cease in menstruation; especially if the cycle had been regular previously. Decreased caloric intake doesn’t allow for the energy required to maintain appropriate hormone levels and conduct these functions throughout the month. This can have a long-term effect on bone health as proper estrogen levels are essential for affective calcium storage. RED-S is often seen in younger females who are not typically concerned with something like osteoporosis; however, bone density peaks between ages 25-30 so this is a crucial period to assure strong bones are being developed! Bone loss can occur in just a few months of having an irregular or absent period. Other symptoms – for both males and females - can include repetitive stress injuries, decreased performance or difficulty training at a high level, dehydration, GI problems, cold intolerance, low heart rate and blood pressure, cramps, fatigue, and brain fog.
Behavioral indicators can also be spotted, including anxiety or depression, body dysmorphia, exercising beyond what’s required, difficulty concentrating, and avoidance of eating or certain eating situations.
RED-S can impair health and sport performance as an under-fueled human is slower and weaker, regardless of the activity being performed! As activity levels remain high despite inadequate fuel, we can see fatigue progress to a loss of strength and muscle size as the body uses this tissue to fuel essential functions. Inadequate fuel can also affect the brain, leading to difficulty concentrating or remaining on task. With these changes in strength, energy, concentration, and coordination, there can also be an increased risk of injury. Along with the potential implications of bone health, stress fractures – and repeated stress fractures – can be a sign of RED-S and inadequate bone density. With that, repeated stress fractures, or unexplained injuries should always be a red flag for further investigating one’s exercise and fueling routine!
So, what can be done to prevent RED-S; to make sure our young athletes and active adults are setting themselves up for success; or to allow you to recognize if you’re trending toward some of these patterns and how to move the dial in the appropriate direction?
As always, consult with a physician if you are concerned about anything discussed above.
In a world where we have people and things to compare ourselves to literally in our palm, it can be easy to constantly ask more of yourself or to continue to push despite signs that you need the opposite. It’s common to think that we’re not doing enough exercise, or the right exercise; or that we need to follow this diet, or that other one you heard about last week. In a lot of instances, we need to fuel ourselves MORE, and more appropriately for what we’re asking our bodies to do. Rest and recovery needs to be recognized and encouraged in order to have the most success… and far more importantly, to take care of our health for the long haul!