Relative Energy Deficiency in Sport - What to know

Relative Energy Deficiency in Sport (RED-S) is a common syndrome that can affect anyone who is active, from weekend warriors and recreational athletes, to sub-elite and elite athletes. Dr Shehnaz Hussain has written us an informative blog about RED-S and how we can take measures to prevent RED-S in our active lives.

RED-S stands for Relative Energy Deficiency in Sport. It has been replaced from the previous concept of the ‘female athlete triad’ as this:

1) affects males as well and 

2) has far more implications than just menstrual abnormalities, low bone density and disordered eating. 

RED-S is now a more encompassing term used to describe a mismatch in energy expenditure to energy intake. If an athlete gets injured often, suffers from stress fractures, has irregular or absent periods, gets respiratory or gastro illnesses often or has poor mental health and they exercise regularly, then RED-S syndrome should be considered as a possible cause (and a reversible one too).

When energy intake is mismatched with output, then vital biological processes start to become impaired one by one and the body focuses on purely just surviving instead of thriving. It dampens down body systems that use up energy such as the brain (which presents as brain fog or fatigue), the immune system (which means you get ill more often), the reproductive system (which presents as irregular or the absence of periods) and your bones (which means you have low bone density and are at increased risk of stress fractures and injury). Initial symptoms may seem trivial such as general fatigue, which can be confused as being due to increasing one’s training load. However, it is often the start of RED-S. 

RED-S can lead to a few kilos of weight loss and then initially improved performance in some sports such as endurance sports. However, this is not sustainable and performance quickly plummets as it is intercepted by complications of RED-S such as injuries, stress fractures, illness, anaemia and fatigue.

What is more worrying, is that in sports such as running, bodybuilding, dancing or gymnastics, losing your period is normalised as ‘part of the game’. This culture can be detrimental to the longevity of the athlete in the sport. Additionally, RED-S can spiral into mental health illness very quickly as poor nutrition can lead to the disruption of important neurotransmitters in the brain which are involved in mood regulation. This along with the high-intensity environment of elite sport can compound into athlete burn out. 

So what can be done to prevent RED-S? Here are some suggestions:

- Discuss the menstrual cycle more openly. The menstrual cycle should be discussed with athletes as much as other performance factors such as sleep, nutrition and life stressors.

- Make sure you consume an adequate amount of carbohydrates prior to each training session. Carbohydrates will provide you with enough fuel to perform at your best and give it your all during each training session, which will inevitably allow you to grow and progress. If you do not have enough carbohydrates or glycogen in your body prior to training, your body next resorts to muscle as an energy source as it is much easier to break down than fat. This can make you fatigue more easily and can hinder muscular growth and therefore athletic performance and progress. 

- Move up a weight class if you are struggling to stay below your current one. Performance increases at higher muscle masses for most sports than at lower muscle masses. It also provides more room for growth and progress. 

- Lead by example and put an end to comments, ‘good’ or ‘bad’, about athletes’ bodies. Only a few sports have anything to do with appearance; keep it that way. 

- Educate yourself on the correct caloric intake for YOU. This however requires time, and access to financial and educational resources which are privileges that not everyone has. If you are an athlete, I would highly recommend discussing with a dietitian or qualified sports nutritionist on the correct macronutrient intake and makeup specifically for your needs. 

Easy ways to fuel up on the go and make sure your get adequate caloric intake is with a few of the Nothing Naughty products. My top recommendations would be the fruit bars or the collagen bars!

Written by Dr Shehnaz Hussain

@shehnazzy @shehnazzy_cooks