What You Need to Know About RED-s As an Endurance Athlete
An unhealthy endurance athlete may seem like somewhat of a paradox, but it’s a lot more common than one might think. RED-s is a syndrome that affects athletes across a plethora of sports, many of whom don’t even know it exists.
What is RED-s?
Energy Expenditure > Energy Intake = Decreased Energy Availability
Formally called the Female Athlete Triad (disordered eating, menstrual disturbance, low bone density), this syndrome was renamed RED-s (Relative Energy Deficiency in sports) in 2014 by the International Olympic Committee as is can affect both males and females. This syndrome is exactly as it sounds; the body is not taking in enough energy to meet the demands placed on it, which can lead to irreparable damage to almost every system of the body if left untreated. Secondary to being a somewhat “new” condition, there is little known in the general medical and athletic community, and it usually takes a drastic injury or mental collapse for an accurate diagnosis. The danger of RED-s is not in the symptoms themselves, but in our failure to recognize them as symptoms.
RED-s can affect athletes competing in a variety of sports, but athletes participating in sports that require high training volumes (such as endurance and ultra-distance sports) have a higher risk of developing RED-s. This is secondary to the high total daily energy expenditure and the challenge of consuming adequate energy to offset this. RED-s is also common in sports with a heavy emphasis on body image such as wrestling, dancing/ballet, swimming and body building.
What are the warning signs and symptoms of RED-s?
· Weight loss/underweight
· Disordered eating (Intentional or unintentional under-consumption of calories)
· Amenorrhea (Periods stopping/becoming irregular)
· Recurrent illnesses (colds/flu, etc.)
· Poor sleep quality
· Recurring stress fractures
· Decreased sports performance
· Iron deficiency
· Cardiac abnormalities
· Psychological signs such as: anxiety/depression/difficulty concentrating/negative body image/mood changes
RED-s manifests itself in a variety of both physical and psychological symptoms which usually start in the form of a simple cold and general fatigue, neither of which typically sound alarm bells. These simple and early symptoms are indicative of the body slowly breaking down and the immune system being suppressed. When there is not enough energy in the body, digestion slows down, resulting in bloating, discomfort, and IBS symptoms. In female athletes, the absence of menstruation is a significant symptom of RED-s. The female body requires a certain amount of energy to create reproductive hormones which then produces a monthly period. Theses hormones are also crucial for bone health, cardiovascular health, and cognitive health. Normal estrogen levels are required to maintain calcium content in the bones. Low estrogen levels allow the bones to become more porous, which progresses to osteopenia and finally osteoporosis. Changes in menstruation can be caused by a variety of issues (other than RED-s) but should always be discussed with your OBGYN as they are never “normal”.
How does RED-s affect Injury Risk?
Risk for injury is increased with RED-s due to impaired recovery from training and impaired adaptation of muscles, tendons, and bones. If your muscles lack proper power and fuel, performance will be impaired. This can lead to sprains, strains and other injuries that seem normal in isolation. Stress fractures due to reduced bone density are also more prevalent with RED-s and can lead to weeks or months of no training.
How is RED-s diagnosed?
Unfortunately, RED-s is often a chronic condition and is “diagnosed” through a process of elimination. There is no specific testing that produces RED-s as a clear diagnosis; it does not show up on blood work or imaging, but abnormalities in any of these tests along with description of symptoms can lead a knowledgeable doctor, PT, coach or athlete to this conclusion.
What is the Recovery/Treatment of RED-s?
With RED-s often taking years to be diagnosed, there is no fast lane to recovery. As many of the physical symptoms grow from a deeply engrained mindset, effective treatment relies on the athlete focusing on their mental health as well as knowledge of adequate nutrition. This process is often very difficult and usually requires professional guidance from a trained psychologist and nutritionist. The key lies in addressing the mismatch between energy intake and energy expenditure. Listening to your body is also very effective in managing/preventing RED-s.
Are you eating enough??
When it comes to nutrition, think of fuel as the ultimate performance enhancer! The act of running can be an appetite suppressant, meaning it can take extra work to fuel your body properly. So how much is enough? General caloric intake for the average person is 1800-2200 according to dietitian Becca McConville. That’s just to make it through life, a baseline for all individuals! If you are a runner or endurance athlete that number must be significantly bigger. Becca recommends adding 70-100 calories to that total per mile per day! For some, you may need to write down everything you eat in a day or use an app to help determine your caloric intake. Others may have a good handle on this and not need to calculate as closely. This will look and feel different for everyone, just be sure to get enough fuel into your engine!
Disclaimer: Nutrition is not my expertise as a PT, so specifics should always be from a dietitian/nutritionist! Several online resources/social media accounts that I enjoy following/learning from are listed in the references. See the charts below for more nutrient specifics and if you have questions about nutrition and proper proportions for you, please seek the advice of a sports dietitian/nutritionist!
Not meeting your energy demands puts you at risk for getting hurt, landing you in a doctor/PT office and ultimately, the sideline. Run Healthy, Run Happy!
Nutritionist IG Accounts to Follow:
@rebeccaeddietitian
@eatwell.runbetter
@fueling_forward
References:
https://www.runnersworld.com/uk/health/a33589189/red-s-relative-energy-deficiency-running/
https://swell.uccs.edu/theathletesplate
