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What Is RED-S? And What to Do About It?


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.



 

Our blogs and articles are not designed to replace medical advice. If you have an injury, we recommend seeing a qualified health professional. We offer both in-person assessments and online consultations!



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