As an athlete, you may experience a condition when you do not have enough fuel to support your body’s energy demands. This is Relative Energy Deficiency in Sport (REDs) that affects the athletes at every level. Relative energy deficiency in sports can cause problems equally for an Olympic medalist or a recreational event competitor. So, if you are an athlete, no matter at what level you are, REDs can drastically affect your long-term athletic performance and overall quality of life, if left unrecognized or untreated.
REDs are a sign of energy deficiency due to insufficient fuel supply. When your body fails to get enough fuel (energy) from food, it gradually adapts reducing fractions that are not important but have a high energy consumption, such as digestion or hair growth. Thus, it leads to several health challenges, including:
- Cardiovascular disorders.
- Hormonal changes.
- Mental health conditions.
- Low immunity to bacterial and viral infections.
- Gastrointestinal problems.
What is Relative Energy Deficiency in Sport?
This term was first introduced during an International Olympic Tournament Organization consensus statement in 2015. Before this, the conditions were restricted to females but the change was made to explain that REDs affect both men and women equally. However, it is more common in females.
Relative energy deficiency in sports is where the body is not taking in enough energy to fulfill the needs placed on it by the amount of workout being performed. This condition is commonly caused by Reduced Energy Availability. This results in an insufficiency of energy for peak sports performance and causes a fall of energy to maintain optimal health, with a vast range of body functions being affected. You can simply understand this with this equation:
Energy expenditure > Energy intake = Decreased energy supply.
Relative energy deficiency in sports was known as the “Female Athlete Triad” in ancient times. The reason behind this name is the major causes of this condition, which were recognized as low bone density, disordered eating, and menstrual disturbance. But afterward, the name was converted to relative energy deficiency in sport because evidence was found that reflects that it occurs in men also and impacts them equally as women.
Who Gets Affected by REDs?
Athletes usually get affected by REDs when they constantly do not consume enough calories to support their body’s energy demands. Consuming fewer calories than your body needs over some time causes a low energy supply. This low-calorie intake leads to several types of health conditions. Whenever your body experiences a low energy supply, it starts to prioritize certain body functions over others. Your body prioritizes the functions essential for sustaining life, such as heart function, breathing, or brain function. Other nonessential but high energy-consuming functions such as hair growth may slow down, which results in health complications. The nonessential functions of your body include:
- Bone repair and formation of new ones.
- Growth and development.
- Menstrual periods.
- Certain hormone production.
Which Sports REDs are Common?
If you’re an athlete and are not getting enough energy through your food, there are higher risks of being affected by REDs. However, the condition is particularly common in:
Endurance sports, such as:
- Distance running.
- Brisk walking.
- Cycling.
- Rowing.
Sports induce leanness or thinness, including:
- Strength training.
- Diving.
- Figure skating.
- Bodybuilding.
- Gymnastics.
Sports involving weight management, Such as:
- Wrestling.
- Boxing.
- Weightlifting.
- Over-training syndrome and REDs
Studies proved that the prevalence of low energy supply in female athletes is higher than in men. For example, female gymnasts experience a low energy supply of 45% more, and female soccer players 35% more than male gymnasts or players. This low energy supply leads to an over-training syndrome that usually occurs if you perform more physical activity than your body can recover from. This condition is caused by hormonal changes that can result in the occurrence of certain symptoms similar to REDs, including:
- Reduced athletic efficiency.
- Intense fatigue.
- Unrecovered exercise.
- Increased risk of injury.
Research has claimed that over-training syndrome and REDs usually share common symptoms that often overlap each other. Healthcare providers sometimes fail to diagnose either condition accurately.
Symptoms of Relative Energy Deficiency in Sport
A stress fracture in an athlete often becomes a cause to think about the diagnosis of REDs. Reduced performance, missed menstrual periods, and excessive fatigue are also signs of Relative Energy Deficiency in sports.
Some common symptoms of REDs are:
- Iron deficiency.
- Cardiovascular diseases like slow heart rate.
- Mood swings.
- Underweight or sudden weight loss.
- Decreases sports efficiency.
- Irregular periods or stoppage of periods.
- Frequent illnesses, such as flu and cold.
- Disordered development or deleted growth in teenagers and children.
- Cognitive problems such as depression, irritability, trouble focusing, and anxiety.
- Hair loss or graying of hair.
- Low blood pressure.
- Low sex drive.
- Hormonal imbalance.
- Bone density loss.
- Digestive issues.
- Repeated injuries in muscles and connective tissues.
All these symptoms show that REDs affect multiple organ systems in your body.
Long-Term Health Risks in Relative Energy Deficiency in Sport
Some of these health risks, if appear, last for a longer duration and cause a permanent loss in an athlete. Such as:
Missed Periods When You Train
Minimum energy supply leads to using spare energy. In this situation the parts of your brain like the hypothalamus and pituitary gland stop or reduce the production of certain hormones, including that which regulate the menstrual cycle in females. Reduction of several such hormones affects the symmetry of ovulation and menstruation in females. These are the earliest signs of low energy supply in female athletes. However, this sign cannot be taken as the most reliable symptom of REDs as several female athletes have vastly different thresholds at which their menstrual cycles are affected. However, missed periods can inform you about your bone health and this is an alarming condition where your overall health may also be at risk. It is also a point to be noted that there are more factors other than REDs that can affect menstruation, such as Polycystic Ovarian Syndrome. Talk to your sports doctor if you experience irregular or missed periods when you train.
Lower Sports Performance
Relative energy deficiency in sports affects sports performance in athletes, in several ways, including:
Injury Risk: Decreased energy supply makes it hard to repair bone-impact injuries, strains, or sprains. Injuries heal more slowly or sometimes, they develop into chronic injuries.
Impaired Recovery: The risk of over-training and chronic fatigue increases manifold because REDs impede the body’s ability to supply enough energy for subsequent training sessions.
Increased Energy Requirements: More energy is required to adapt to training but deficient energy supply drastically affects the growth, cardiovascular, and muscle adaptations.
Low energy supply to working muscles results in a more rapid onset of fatigue. Muscle strength and muscle size are also reduced due to several factors including stress hormone (cortisol) imbalance, low production of testosterone hormone both in men and women, and neuromuscular disorders.
Increased Injury Risk
Over-training and impaired recovery lead to increased injury risk and impaired adaptation. The gradual strengthening of muscles, bones, and tendons with exercise becomes a hard task. Impaired concentration or coordination also causes an increased injury risk. In addition, reduced bone density also causes stress fractures that are common and missing weeks or even months of training.
Causes and Risk Factors of REDs
Burning more calories than you take in over a period of time, as an athlete, may develop relative energy deficiency in sports. This gradual energy disturbance is sometimes intentional and sometimes it is accidental. If an athlete competes in endurance sports, they have energy demands that greatly exceed the needs of a non-athlete. They may experience under-eating for many reasons such l; a lack of appetite or challenges with meal planning.
Under-eating sometimes is caused by some physiological factors. In addition, some sports that emphasize leanness or weight, also urge the athletes to be under-eat to maintain a specific body size and shape required for competition. For many sports, athletes get motivation from improving their strength-to-body-weight ratio and performance.
Risk Factors
Several risk factors cause an increase in the occurrence of REDs. The following are the features of an athlete who has a higher risk of REDs:
- Professional or competitive athlete.
- Feeling pressure to perform at a higher level.
- Having depression.
- Participating in sports that emphasize leanness or require a certain weight.
- Taking excessive exercise.
- Focusing on maintaining a certain body shape.
Diagnosis of REDs
Most of the bone density is formed during your teenage years. Reduced bone formation in childhood or adolescence may lead to long-term bone health problems, such as osteoporosis or bone weakness. This also affects the fertility of the individual if remains untreated for a longer period. However, the good news is that you can reverse most of the health consequences of REDs if you pick them up early. This means an early diagnosis or guidance from an experienced medical team can expect improvements in your overall health, well-being and performance.
Doctors usually diagnose RED-S after determining that an individual meets the criteria of diagnosis. They may ask them about their exercise and eating schedules. Athletes who qualify the certain standards may proceed for further RED diagnosis. However, self-reporting is not enough for this purpose. In addition to screening, certain tools are also used. For example, doctors may look for physical symptoms of REDs. They try to find the problems in their:
- Gastrointestinal health.
- Endocrine system.
- Metabolism.
- Heart heart health.
- Growth patterns.
- Bone health.
- Mental health.
- Immune system.
- Reproductive and menstrual health.
Doctors re-examine the symptoms during routine check-ups. If they find any physical signs like those listed above, they may refer you to a full diagnostic exam for REDs.
Treatment of Relative Energy Deficiency in Sport
Treatment REDs is based on the athlete’s symptoms because every athlete with REDs has different symptoms. The individualized treatment of REDs focuses on an athlete’s bone stress injury, performance decrease, recurrent infections, and menstrual imbalance. The doctors also keep an eye on the personal circumstances and sports goals of athletes during RED treatment.
The main thing to focus on while taking steps for treating REDs is the mismatch between energy expenditure and energy intake by an athlete. A sports dietitian guides athletes to make a balance between the demand for energy and the working of muscles in the athlete’s body. This may help maintain the optimal health of an athlete to improve their optimal performance. Abrupt increases or decreases in energy supply often cause slower or faster performance in athletes. Here you have to understand the demands of elite and competitive sports so that this may help you focus on both performance and health.
Management and Prevention of REDs
Educating yourself about the potential harms of consuming enough energy for a specific training exercise can help you and your athletes prevent REDs. You should have developed a plan to ensure adequate nutrition. In addition, joining educational programs to focus on increasing nutritional knowledge and recognizing disordered eating patterns may also help improve your energy supply. The most effective ways to prevent REDs include:
- Scheduling adequate periods of rest during your exercises.
- Incorporating enough protein, fat, and carbohydrates into your regular diet.
- Ensuring that the amount of food you eat is matching with your activity level.
In addition, the team of nutritionists, dietitians, and physical trainers can potentially help you prevent REDs and improve your energy availability as well. You may get advantages while taking advice from experts in the following fields:
- Sports-specific coaches.
- Nutrition experts.
- Sports scientists.
- Sports psychologists.
- Sports pharmacists.
Moreover, mild symptoms of REDs can be managed easily with some dietary changes alone. However, if you have prolonged or severe symptoms of relative energy deficiency in sports, you may take time off from workout training and seek medical assistance from a mental and physical health professional.
Conclusion
Relative Energy Deficiency in Sport is a condition developed in athletes or people involved in frequent physical activities. This is the low amount of energy that is not enough to meet the energy requirements of athletes. It also leads to many diseases such as intense fatigue, frequent illnesses, and anxiety attacks.
Its treatment is easy. Increasing calorie intake to meet the energy demands of the body when training can help manage the symptoms of REDs. However, the treatment of prolonged and intense symptoms is difficult. Working with experts in physical health, mental health, and nutrition can help you prevent REDs and improve your performance.
