What is RED-S and does it only occur in females?
Lauren Kendall is a physiotherapist located in South Hurstville at Formation Physio. Lauren has a special interest in Women’s Health and sports injuries. Today she chats about Relative Energy Deficiency in Sport.
What is RED-S?
RED-S refers to when the body isn’t consuming sufficient energy to support the demands of the intensity/amount of exercise being performed. This results in not only inadequate energy for peak sports performance but also inadequate energy to maintain optimal health.
Energy expenditure > energy intake = decreased energy availability
Symptoms of RED-S
It often isn’t until an athlete sustains a stress fracture that a diagnosis is made. However it can be identified earlier by reduced performance, excessive fatigue and stopped/missed menstrual periods. Other symptoms of RED-S can include:
Weight loss/underweight
Recurrent illnesses such as cold/flu’s
Mood changes
Delayed/disordered growth/development (children and teenagers)
Iron deficiency
Affect of RED-S on Sports Performance
Increased onset of fatigue due to decreased energy availability to working muscles
Decreased muscle size and strength
Impaired recovery with the increasing risk of overtraining and chronic fatigue
Injury risk as healing time increases and/or can develop into chronic injuries
Stress fracture risk due to decreased bone density
Long Term Health Risks of RED-S
Majority of bone density is formed during teenage years. If bone formation is decreased in adolescence or early adulthood, it can result in long term issues with bone weakness and osteoporosis. Longer term health such as fertility can also be impacted, however, most of the health consequences from RED-S are reversible when detected early.
RED-S in Females
Changes in menstruation are often one of the earliest signs of low energy availability**. When there is limited energy available, the hypothalamus and pituitary (glands that regulate many of the body’s hormones) decrease or stop producing certain hormones, which include the ones that support the female menstrual cycle.
Delayed or missed periods can be a warning sign that bone health and other aspects of health may be compromised. Bone mass density (BMD) reduces as the number of missed menstrual cycles increases. Stress fractures are more common in physically active women with menstrual irregularities and/or low BMD with a relative risk of stress fractures two to four times greater in amenorrheic than eumenorrheic athletes.
**note: not always the most reliable as different females have different thresholds at which their cycle is impacted and other conditions such as PCOS can affect the menstrual cycle
RED-S in Males
As with females, the body’s hormones are impacted, with reduction in testosterone likely to be of greatest concern. Males with cyclical changes in body mass and composition, prolonged inadequate energy intake, punctuated changes in training volume/intensity and participation in strenuous endurance events without accompanied changes in nutrition place males at highest risk.
Treatment of RED-S
Athletes can be categorised into red, yellow and green zones depending on their presentation and symptoms, therefore treatment varies for each patient. Treatment should focus on correcting the relative energy deficit through increasing energy intake and/or decreasing energy output; addressing any injuries sustained and working through prevention of any further injuries.
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References
Relative Energy Deficiency in Sport (RED-S)British Journal of Sports Medicine 2015;49:421-423.
Mountjoy M, Sundgot-Borgen JK, Burke LM, et alIOC consensus statement on relative energy deficiency in sport (RED-S): 2018 updateBritish Journal of Sports Medicine 2018;52:687-697.
STAND, P. (2007). The female athlete triad. Med. Sci. Sports Exerc, 39(10), 1867-82
Perth Sports Medicine. Relative Energy Deficiency in Sport. Available from: https://www.perthsportsmedicine.com.au/relative-energy-deficiency-in-sport-perth-claremont-cockburn-wa.html
