How It Can Impact Athlete Performance and Health
As an athlete, you are probably always looking for ways to improve your performance, meet your exercise goals, and avoid injury. Frequently, athletes attempt to do this by making changes to their dietary intake and/or training schedule. However, if done incorrectly, you can actually risk negatively impacting your performance and health! In recent years, research has shed light on the mechanisms behind decreased performance and health in both male and female athletes who are not meeting their nutritional needs. This phenomenon is called Relative Energy Deficiency in Sport, or RED-S.
What is Relative Energy Deficiency in Sport (RED-S)?
RED-S stemmed from another phenomenon called the Female Athlete Triad, which is characterized by the interrelationship of low energy availability (not eating enough calories), menstrual dysfunction, and decreased bone mineral density found in female athletes. RED-S expands on this concept to highlight how low energy availability affects both female AND male athletes, and can also negatively impact endocrine, metabolic, hematological, immunological, gastrointestinal, cardiovascular, and psychological function, as well as growth and development.
What causes RED-S?
Low energy availability is at the core of RED-S, and leads to the other negative health effects. Low energy availability occurs when exercise energy expenditure is higher than energy intake. This can happen for a lot of different reasons—the athlete may just have no idea of their nutritional needs, and therefore may be eating much less than needed. They may have just switched from off season to higher intensity workouts, but didn’t adjust their intake. The athlete may be in a weight-class sport, or one that associates thinness with increased performance. The athlete may also be unable to meet nutritional needs due to financial limitations, or due to lack of planning to bring snacks or meals as needed to eat before, during, or after school, practice, or games.
How does this impact performance?
When the athlete is not eating enough to offset exercise, the associated metabolic changes can lead to decreased muscle strength, endurance performance, training response, coordination, concentration, and glycogen stores. These factors prevent both strength and endurance athletes from meeting performance goals. Furthermore, RED-S can lead to increased injury risk through decreased bone mineral density, which leads to increased risk of a bone stress injury. Female athletes with menstrual dysfunction, such as irregular or missing menstrual cycles, are at particular risk. The immune system may also be impacted, potentially leading to increased likelihood of illnesses that can cause athletes to miss practices, games, or races.
RED-S can also cause irritability, depression, and impaired judgement. This can strain relationships with teammates or coaches, or affect the athlete’s ability to make good decisions during an event or game.
Who is at risk of Relative Energy Deficiency in Sport?
Both female and male athletes can be affected by RED-S. Athletes in weight-class sports may be at risk due to diet cycling used to “make weight”. Sports that encourage leanness, aesthetics, or endurance, such as cyclists, rowers, runners, gymnastics, ballet, or figure skating, may be at increased risk. However, it is important to remember that athletes of any sport can be at risk of RED-S.
Is RED-S an eating disorder?
No, but it may arise as a complication of one. Eating disorders are complex mental illnesses which arise for a variety of reasons, including cultural, familial, psychological, physiological, and genetic influences. An individual may already have an eating disorder and join an athletic team, and the increased exercise energy expenditure exacerbates their already low energy availability. Or an individual may experience pressure to lose weight to improve performance by coaches and teammates, leading to development of an eating disorder. Regardless of etiology, eating disorders pose serious health risks to athletes and should be addressed as soon as they arise.
How can you screen for Relative Energy Deficiency in Sport?
Considering all of the health and performance risks discussed, early detection of RED-S is key for athletes. As the Female Athlete Triad has been researched more than RED-S so far, more validated screening tools are currently available for female athletes, including the Athletic Milieu Direct Questionnaire (AMDQ), Female Athlete Screening Tool (FAST), and the Brief Eating Disorders in Athletes Questionnaire (BEDA-Q). The Low Energy Availability in Males Questionnaire (LEAM-Q) is still being developed. However, eating disorder screening tools for the general public are available, such as the Eating Disorder Inventory (EDI) and Low Energy Availability in Females questionnaire (LEAF-Q). While not specifically designed for athletes, these still may be helpful in identifying individuals who are not meeting energy needs.
How can you prevent RED-S?
The first step to preventing RED-S in athletes is awareness of what this condition is—so you’re off to a great start after reading this blog! Unfortunately, survey research shows that a lot of physicians, coaches, trainers, and athletes are unaware of both the Female Athlete Triad and RED-S. Through sharing this blog with coaches, teammates, and friends, you can help spread awareness of how this phenomenon negatively impacts health and performance.
Lastly, ensuring that you are consuming enough calories and nutrients to offset exercise expenditure, boost performance, and meet goals is key. Keep in mind that nutritional needs will vary depending on age, gender, size, sport, and training schedule—so what works for your friend or teammate likely will not work for you. The best way to make sure you are meeting your needs is to meet with a professional sports dietitian, who can help you meet your exercise and performance goals without putting your health at risk! Find out more about how Nutrition Heartbeat can help YOU meet your goals here.
By Katie Lamps
References
- Mountjoy M, Sundgot-Borgen JK, Burke LM, et al. IOC consensus statement on relative energy deficiency in sport (RED-S): 2018 update. International Journal of Sport Nutrition and Exercise Metabolism. 2018;52:687-697.
- Nazem TG and Ackerman KE. The female athlete triad. Sports Health. 2012;4(4):302-311.
- Knapp J, Aerni G, and Anderson J. Eating disorders in female athletes: use of screening tools. Nutrition and Ergogenic Aids. 2014;13(4):214-218.
- Logue DM, Madigan SM, Melin A, et al. Low energy availability in athletes 2020: an updated narrative review of prevalence, risk, within-day energy balance, knowledge, and impact on sports performance. Nutrients. 2020;12(3):1-19.