Nutrition and athletic performance often go hand in hand. While it’s typical to see athletes watching and managing what they eat, consuming fewer calories than their body requires to perform at their activity level can lead to a very serious condition know as Relative Energy Deficiency in Sports (RED-S), or what had previously been know as the Female Athlete Triad. If you find that the signs and symptoms of RED-S described below apply to you, contact our office or check out our services for support.
Athletes often feel pressure to alter their bodies or micromanage the foods they consume to perform better in their sport. This often manifests in restrictive eating patterns, resulting in the athlete consuming fewer calories than their body requires to keep up with their level of activity. This leads the body to not have enough energy or fuel to function properly. The body becomes energy deficient when the amount of energy used (calories burned) is greater than the energy (calorie) intake. Although this is primarily used to identify athletes, it can also affect anyone who is participating in regular exercise. Unlike the paradigm of the female athlete triad, RED-S is helpful in identifying disordered eating and other issues related to inadequate energy intake in active individuals of all genders. If the energy deficit continues, the athlete often experiences decreased performance in their sport, irritability, mental health disorders, and physical injuries like stress factors. It used to be thought that eating disorders, particularly in sports were female-specific. As research and awareness has grown, this has been vastly disproven.
Often sports require frequent weight-checks and stipulations around weight and body for their athletes (i.e. wrestling, rowing, gymnastics, etc.). This is often where athletes begin to manipulate their food intake to achieve goals around weight and/or body composition. Research on RED-S has found that calorie-deficiency has quite the opposite effect of what is often intended -- to lose the “fat”.
What is body fat and why do we need it?
Body fat is tissue that stores energy and serves to protect vital organs like the heart, kidneys, and liver. It is also important for hormone function and stores energy that is important when the body’s needs are increased (i.e. intense physical exercise). When our bodies use fat stores and are not able to restore it, the body does all it can to protect those organs.
WHY IS IT IMPORTANT TO IDENTIFY RED-S?
Hormones such as oxytocin, insulin, and growth hormone and cortisol are all impacted by RED-S. These hormones provide support for the body’s digestion, managing inflammation, building and maintaining strong bones, and supporting mental health. When the body is not getting the energy it needs to function properly, it shifts to survival mode and begins optimizing tasks that are necessary for survival and suppressing tasks that are not immediately needed. This often looks like the suppression of hormones that contribute to sexual function, menstrual cycle, and growth/development. All of these shifts take place to make sure that the vital organs are protected and are able to function well enough for the body to survive. It's like when money is short and you can't pay your bills. You conserve energy where you can -- turn off the lights, run the heater or a/c less, take shorter showers, stop going out for coffee, eat-in, carpool. You can not fully function and engage in your daily activities.
The potential health consequences of RED-S shown in diagram above. Psychological problems can be both the result of and the cause of RED-S.
HOW TO IDENTIFY RED-S
1. CONSISTENT LOW CALORIE INTAKE AT MEALS
Restriction resulting in lower caloric intake throughout the day is the hallmark of RED-S. This is what causes the actual energy deficiency, as they are not consuming enough energy to support what they are expending during physical activity. The body adapts to this low calorie availability by shutting down hormones, biological functioning, and appetite. The athlete will likely feel fatigued and may avoid communal meals to avoid attention and pressure to eat more. They also may not recognize these shifts and how they are being affected because the body has adapted to its new norm. Their body is not prepared to function to the best of its ability, severely impeding the athletes health and performance.
2. STRESS FRACTURES
Stress fractures are a result of the hormonal shifts occurring in the body, preventing bones from absorbing calcium. This is detrimental to the integrity of bones. Athletes who experience multiple stress fractures should be evaluated for RED-S to ensure their health and well-being.
3. GI ISSUES
Slowed digestion is the body’s attempt to preserve energy and while also optimize the nutrition it is provided. This often looks like discomfort when eating and delays in the stomach’s ability to empty and in the intestines’ ability to move food through the digestive tract -- dehydration, blowing, feeling very full with little food, nausea, constipation. (Not. Fun.)
4. MISSED MENSTRUAL CYCLE
Female athletes often lose their period (amenorrhea) when they experience an energy deficit. Again, this is the body’s attempt to preserve all the energy it can a redirect energy to fuel “essential” functions like protecting vital organs and the brain. This can be a solid indicator of RED-S, though if an athlete is not experiencing amenorrhea, RED-S should not be ruled out yet. Every body is different and every body will respond differently to low intake.
- UNDERSTAND THAT FOOD FUELS!
A lot of misinformation is available via social media and the great big world of the internet. It is important that athletes and coaches receive accurate information on how to fuel their bodies and how to optimize their nutrition for performance in their sport. If you want to get some solid information on sports nutrition and RED-S, Fiona Sutherland’s podcast, The Mindful Dietitian has some great info in her chats with Paula Quatromoni and Nicola Rinaldi. MarciRD has some awesome reads on fitness, exercise, metabolism, and body image!
- GET RID OF DIET TALK!
Diets are not helpful and will result in restriction. Diets provide false information on the function of nutrition and its relationship with the body. It’s time that we change the conversation within teams to support adequate nutrition, rather than creating fear around food and the body. Diets do not work and are particularly harmful to an athlete who requires even more energy to support the high-functioning activity required by sport. The keto diet, the paleo diet, intermittent fasting, bio-hacking, all promise optimum performance through restriction and strict rules around food. Restriction only leads to deficiency and the cascade of effects we have been talking about. Remember, if the calories are not coming in, you don’t have any to burn for energy effecting overall health and performance. Diets are not helpful and will result in restriction, so just throw it out the window!
- CHECK IN -- CREATING A CULTURE OF DISCUSSION
RED-S may result in declining mental health, or declining mental health may result in RED-S. A team culture of check-ins can help athletes talk through the pressures of the sports and give teammates and coaches the opportunity to provide support for their athletes. If you’re an athlete looking for resources, I encourage you to check in with a coach, teacher/professor that you are comfortable with. Schools also provide counselors, doctors, dietitian and other health services that can give you support in fueling your body appropriately.
No matter your performance level, sport is an art, our bodies are the vessels through which this art is created, and it is important to properly fuel and support it. Coaches, parents, and teammates are important in identifying athletes who are struggling with eating disorders and disordered eating. Athletes are likely to feel pressure around their body and their sport.