Introduction
If you are feeling fatigued, lacking concentration, or performing poorly despite the amount of training, this blog might be for you! RED-S refers to Relative Energy Deficiency in Sports, a condition that affects athletes whose energy availability is insufficient to support their daily activities. Without appropriate management, RED-S can long-term impact athletes' physical and psychological health.
Risk Factors
High training volume
Psychological stress leading to eating disorders
There is pressure to maintain body image in "weight-sensitive" sports, such as cheerleading, dance, gymnastics, swimming, boxing, and weightlifting.
Symptoms
Disruption of menstruation cycle in females
Amenorrhoea: absent of menstruation for more than three consecutive cycles
Ogliomenorrhoea: menstruation cycle for more than 45 days
Chronic fatigue
Decreased bone mineral density leads to risks of stress fractures/ osteoporosis.
Eating disorders: moving between anorexia nervosa (restriction of food intake) and binge eating due to weight/ body type requirement of sports
Anaemia
Hair Loss
Mood changes (This can either be a cause or a result of RED-S), including depression, irritability and anxiety
Poor performance- decrease in concentration, strength, coordination and endurance
Stunted growth in adolescents (height below average)
Symptoms of RED-S can be quite subtle and difficult to spot, and therefore, clinicians and athletes themselves always miss them. The "no pain, no gain" culture in sports further discourages athletes from accepting their symptoms, which further delays intervention.
How To Prevent RED-S
Education to address and improve the unhealthy culture of weight in sports for athletes and sports organisations
Increase awareness of the negative impacts of low energy availability on athletes.
Treatment
A multi-disciplinary approach can address RED-S in different aspects to help athletes return to sports.
Dietitians: to help increase energy intake
Increase calorie intake by 300-600 kcal/ day with a balanced diet
Adequate carbohydrate and protein intake
Increase calcium and Vitamin D intake for bone health
Coaches/ Physiotherapists
Reduce training times and intensity in the early stages
Increase resistance training to improve bone health
To stop athletes at risk from training if necessary until energy levels are stabilised
Psychologist
Counseling and therapy to help athletes with mood changes and eating disorders
Cognitive behavioural therapy
Athletes
Goal setting to improve weight and body image
Acceptance of the condition and take incremental steps to return to sports under guidance
Conclusion
RED-S can be caused by the over-emphasis on weight in sports. Prolonged reduction in energy availability can affect athletes' performance and health. A multidisciplinary approach and education are essential to help athletes return to sports.
References
Mountjoy, M., Sundgot-Borgen, J., Burke, L., Carter, S., Constantini, N., Lebrun, C., ... & Ljungqvist, A. (2014). The IOC consensus statement: beyond the female athlete triad—relative energy deficiency in sport (RED-S). British journal of sports medicine, 48(7), 491-497.
Mountjoy, M., Sundgot-Borgen, J., Burke, L., Ackerman, K. E., Blauwet, C., Constantini, N., ... & Budgett, R. (2018). International Olympic Committee (IOC) consensus statement on relative energy deficiency in sport (RED-S): 2018 update. International journal of sports nutrition and exercise metabolism, 28(4), 316-331.
Todd, E., Elliott, N., & Keay, N. (2022). Relative energy deficiency in sport (RED-S). British Journal of General Practice, 72(719), 295-297.
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