RED-s
One of my great passions is ‘holistic athlete health’ as well as ‘preventative health’ (injury screening, injury risk factors etc.). This doesn’t mean I’m checking chakras whether ‘Jupiter has entered your house of health’, this means trying to identify real, evidence-based risk factors for potential injury and poor health.
This passion, as well as being involved with sports throughout my whole life, led me to research more into something called the Female Athlete Triad. This has been re-named since I first came across it and is now known as Relative Energy Deficiency in Sport (RED-S). This is relatively new in the world of sports medicine and, as such, not many people are familiar with how to identify the risk factors and deal with the symptoms of the Triad.
RED-S is a medical condition, predominantly occurring in highly-physically active women. There are three major components;
Low energy availability (EA) +/- disordered eating
Low bone mineral density
Menstrual dysfunction
EA is the reserve of energy remaining once training and physiological demands (metabolism, activities of day to day living etc.) have been accounted for.
Caloric intake - Exercise demands – physiological demands = Energy Availability
Low bone mineral density stems from the bodies inability to lay down new bone. This results in ‘brittle bones’ and can lead to early onset osteoporosis and higher likelihood of stress-fractures.
Finally, menstrual dysfunction refers to a change in the overall regularity or presence of the female period. This can range from disturbed or irregular periods to complete absence.
Each of these key components is inter-related. Energy deficiency can result in inadequate available energy for regular bodily function and therefore amenorrhea (loss of regular menstruation) can develop. Low energy coupled with low oestrogen also causes reduced bone-mineral density.
Furthermore, these symptoms can be considered to be dynamic spectrum, ranging from normal/healthy people, to those within the end range of the Triad, as seen below.
Early intervention is key in reducing the negative health and performance aspects of the Triad. For example, we know that 90% of bone mass is attained by 18 years of age. Therefore, early recognition of RED-S can reduce the likelihood of permanent detriment in long term bone health.
Due to their close-interrelatedness, it is important that once one factor has been identified in an athlete, that they are thoroughly screened for others. Screening is conducted by a trained health/medical professional and revolves around getting to know an athlete, as well as their history. Screening questions are likely to include;
When was your most recent menstrual period?
How many periods have you had in the past 12 months?
Do you worry about your weight?
Are you on a special diet or do you avoid certain types of foods or food groups?
Have you ever had a stress fracture?
Have you ever been told you have low bone density (osteopenia or osteoporosis)?
These and far more in-depth questions are then coupled with a physical assessment. A patient is then able to be stratified into a high, medium and low risk group.
Some athletes may be tempted to think, “Eh, I didn’t need a period anyway!”. To any of them I would say, if your body decided it is incapable of sustaining basic functions, maybe it’s time for some reflection?
Even at the low risk of the spectrum, a person is likely to experience gradual reduction in performance through symptoms such as; decreased endurance, increased risk of injury, poor response to training, decreased glycogen stores and decreased muscle strength.
A moderate to high risk person experiences the aforementioned reductions in physical performance as well as more systemic issues. These may include; impaired cognitive function, decreased coordination, decreased concentration, irritability and depression.
Fella’s you’re not exempt! A revising of the Female Athlete Triad in 2014 by the International Olympic Committee meant that the phrasing was changed to include all athletes, not just females, into the disorder. Hence the all-encompassing diagnosis was renamed ‘Relative Energy Deficiency in Sports’.
Treatment of RED-S will involve a multidisciplinary team of medical & health professionals due to the complex and systemic nature of the disorder. The crux of RED-S is there is simply not enough caloric intake to be able to maintain bodily functions with the current level of exercise. Therefore, is it critical to understand the mantra, ‘eat to perform’. However, I must admit this is coming from a husky-gent who never says no to a second helping.
To be honest, I can really understand where someone who is trying to perform at their highest capacity can come unstuck. Dropping weight to perform better is a realistic way to improve performance, in some circumstances. However, there is a limit and eventually returns diminish and performance and health suffer.
Overall, RED-S is a complex phenomenon and requires an astute team to help achieve balance. Although energy availability is at the heart of RED-S simply eating more isn’t usually a good long-term fix. If you’re unsure if you, someone in your team or an athlete you manage/coach may be suffering from RED-S, a judgment free conversation and a gentle nudge to a health professional is be a great start. Identifying the issue early is an excellent way to get on top of it and begin to make changes to better health and performance!