Understanding Relative Energy Deficiency in Sport (RED-S)
Formerly known as the female athlete triad, Relative Energy Deficiency in Sport (RED-S) is a serious condition that is defined as impaired physiological functioning caused by relative energy deficiency.
More simply, RED-S occurs when your body is not taking in enough energy to meet the demands placed on it by the amount of exercise being performed for a prolonged period of time.
RED-S can have various negative implications on your body’s essential biological systems. These impairments include but are not limited to, impairments of metabolic rate, menstrual function, bone health, immunity, protein synthesis, and cardiovascular health. This can have devastating effects on athletes’ performance within their sport.
Although RED-S can affect athletes of any gender in any sport, it is most common in sports and activities where low body weight and leanness are important for performance (e.g., long distance running etc.), aesthetics (e.g., dancing etc.) or to meet a weight category (e.g., boxing etc.). Elite athletes and athletes who have recently increased the intensity of their athletic training are also at a higher risk of developing RED-S.
What causes RED-S?
RED-S is caused by a prolonged state of Low Energy Availability (LEA). While it is generally associated with disordered eating, LEA can also be invertedly caused by the following situations:
- Insufficient understanding of your individual energy needs
- Changes to training or competition load not matched with increased energy intake
When your body is in a prolonged state of LEA, your body will attempt to conserve energy by depressing essential biological systems and inhibiting the production of hormones in the reproductive system. This can have a series of negative implications on both your health and athletic performance.
What are the symptoms of RED-S?
RED-S can manifest in a variety of physical and psychological ways. Unfortunately, the symptoms of the condition are often overlooked as many women also put their signs and symptoms down to simply ‘being tired’ and do not seek medical advice.
A key symptom of RED-S seen in female athletes is amenorrhea, or the absence of a period, as it signals a change in your body’s intricate hormone system. This occurs when your body perceives too large a gap between energy intake and energy expenditure causing estrogen levels in the body to drop and your menstrual period to stop. This can have adverse effects as consistent low estrogen levels can cause your bones to become progressively more porous, increasing your risk of developing osteopenia, osteoporosis and stress fractures.
Other signs and symptoms to look out for include the following:
- Weight loss
- Chronic fatigue
- Reduced muscle mass
- Fractures without significant trauma
- Disordered or abnormal eating
- Altered sleeping patterns
- Mood or social behavioural changes
- Increased infections and illnesses
- Decreased resting metabolic rate
- Decreased ability to recover from injuries (slower tissue repair)
- Decreased motivation to train
- Impaired athletic performance
How can RED-S affect your performance?
RED-S can have numerous adverse health and athletic performance consequences, impairing both your health and sporting performance. Due to its effect on your body’s essential biological systems, if left untreated RED-S can have serious consequences on your athletic performance and health long term.
Potential performance effects can include:
- Decrease performance and training response
- Decreased endurance performance
- Decreased muscle strength
- Decreased glycogen stores
- Decreased co-ordination
- Decreased concentration
- Increased risk of injury due to impaired recovery
- Impaired judgement
- Irritability
- Depression
How is RED-S diagnosed?
Diagnosis can be difficult as everyone’s body responds differently to LEA and the signs and symptoms of the condition can be subtle and have crossovers.
As early detection is crucial to improve performance and prevent long term consequences, you should consider RED-S if you have noticed any of the above changes in your health and performance.
The diagnosis of RED-S involves a multi-disciplinary approach and requires medical assessment. This can involve blood tests to assess hormone levels, bone scans to assess bone health and/or metabolic rate testing. There are also various screening tools for RED-S that can assist with this process (i.e., the REDS clinical assessment tool).
How can RED-S be treated?
Treatment for RED-S should be conducted by working with an interdisciplinary team (i.e., doctor, dietitian, and psychologist) and be individualised based upon your symptoms, sport, goals and personal circumstances.
The key component treatment should address is the disconnect between energy intake and energy expenditure. This can be achieved by generally increasing dietary intake of energy and/or reducing energy expenditure by limiting exercise intensity and quantity, where possible.
Additional treatment may also be required to address your menstrual and bone health, as well as any psychological conditions you may be experiencing.
If you are interested in getting more information, we recommend consulting a qualified sports medicine practitioner to get started.
When should I seek medical advice about RED-S?
If you have concerns about RED-S impacting your life and athletic performance, we encourage you to get in touch with us. We have a network of specialised General Practitioners, gynaecologists and fertility specialists across Australia who will be more than happy to speak with you and discuss your individual circumstances.
With over 50 dedicated specialists across 70 consulting locations throughout the country, our friendly staff can help you choose the right medical professional to guide you and help you achieve your sporting goals. Contact us now.
