Relative Energy Deficiency in Sport (RED-S): Revolutionising Sports Culture for Athlete Health and Performance

Relative Energy Deficiency in Sport (RED-S) represents a significant issue in the realm of athletics that transcends gender but has a particularly stark impact on female athletes. RED-S arises when an athlete does not consume enough calories to support their energy expenditure, leading to detrimental effects on health and performance. This post aims to explore the complexities of RED-S, focusing on its implications for female athletes, while providing preventative measures, diagnostic criteria, treatment protocols, and insights on how osteopathy can play a pivotal role in addressing RED-S.

Eye-level view of a dedicated female athlete training

Understanding RED-S and Its Effects

Understanding RED-S is critical for athletes, coaches, and sports professionals. The condition highlights a broader spectrum of health implications, beyond the traditional energy deficiency concept that is often confined to disordered eating or low energy availability. Symptoms include menstrual dysfunction, reduced bone density, and subsequent injuries, considerably hampering an athlete's ability to perform (1). The prevalence of RED-S in female athletes is distressing; studies indicate that as many as 58% of elite female athletes may experience disordered eating patterns, which can lead to RED-S (2).

The impact of RED-S extends far into an athlete's performance capability. Underperformance due to restricted energy availability can hinder an athlete's endurance, strength, and technique, ultimately impairing competitive edge (3). Importantly, the mental health consequences of RED-S, such as increased anxiety and depression, cannot be overlooked, as they further exacerbate physical issues and impact overall athletic performance.

High angle view of sports training session with healthy snacks

Signs and Symptoms of RED-S

Identifying the signs and symptoms of RED-S can significantly aid in early diagnosis and intervention. Common indicators include excessive fatigue, lack of energy, recurrent injuries, poor recovery from training sessions, and mood fluctuations (4). Moreover, menstrual irregularities serve as a major red flag, particularly amongst female athletes. A study revealed that 32% of female athletes reported irregular or absent menstrual cycles (5). The connection between energy deficiency and menstrual dysfunction must not be underestimated, as it is a clear signal of underlying health issues.

Additionally, behavioural changes such as obsessive calorie counting, avoidance of social situations related to food, and preoccupation with body weight may accompany RED-S symptoms (6). Coaches and team staff should be prepared to recognise these signs and approach the subject delicately to facilitate a supportive environment for affected athletes.

Preventative Strategies for RED-S

Addressing RED-S effectively requires systemic changes within sports culture aimed at prevention. Education programmes for athletes, coaches, and support staff are paramount in raising awareness about energy needs and the importance of a balanced diet (7). Emphasising the significance of nutrition in athletic performance is essential, as many athletes may have misconceptions regarding caloric requirements or the value of carbohydrate intake.

Moreover, regular monitoring of athletes' health — including body composition, menstrual health, and overall well-being — is crucial (8). Implementing routine assessments can facilitate early detection and intervention, aiding athletes in achieving their performance objectives while maintaining their health.

Support systems, including sports nutritionists and mental health professionals, should be integrated into athletes' training regimes. Athletes must have accessible resources to discuss their nutritional choices and mental health issues without fear of stigma (9). Through open dialogue about these topics, the sports community can cultivate a more understanding and supportive atmosphere.

Close-up of a healthy meal prep ideal for athletes

Diagnostic Criteria and Treatment Protocols

Diagnosing RED-S involves a comprehensive assessment that includes reviewing an athlete's dietary habits, training loads, and psychological factors. Healthcare professionals can employ tools like the Eating Disorder Examination (EDE) and the Female Athlete Triad Coalition Consensus Statement to aid in diagnosis (10). Standard tests might also include bone density scans, blood tests to assess hormone levels, and psychological assessments to better understand the athlete's mindset towards food and body image.

Once diagnosed, treatment protocols should focus on restoring energy balance and emphasising nutritional rehabilitation. Engaging with a registered dietitian is advantageous, as they can tailor a nutrition plan suitable for athletes' individual needs while ensuring that caloric intake meets energy expenditure (11).

Counselling for psychological support can assist athletes in navigating the emotional challenges tied to RED-S. Cognitive behavioural therapy can be effective in addressing unhealthy thought patterns surrounding food and body image, thus aiding recovery (12). Furthermore, behavioural interventions focusing on goal setting and self-monitoring strategies are integral to successful recovery.

The Role of Osteopathy in Supporting Athletes with RED-S

Osteopathy presents a beneficial approach for athletes suffering from RED-S, as it not only manages symptoms but also fosters a holistic understanding of health. Osteopathic principles focus on the body as a whole, recognising that physical, mental, and nutritional aspects are interconnected (13). Osteopaths can aid athletes in addressing the physical consequences of RED-S, such as muscle tightness, joint pain, and increased injury rates.

Manual therapies offered by osteopaths can enhance circulation, promote muscle relaxation, and improve range of motion, vital for athletes recovering from injuries related to RED-S (14). Additionally, osteopathic techniques can help manage stress and anxiety levels, promoting mental clarity and emotional resilience during recovery.

Furthermore, osteopaths can collaborate with dietitians and mental health professionals to provide a well-rounded care plan that addresses all aspects of an athlete's health. This multidisciplinary approach is crucial in ensuring minimal disruption to training and performance.

Promoting a Positive Sports Culture

In conclusion, combating RED-S necessitates a shift in sports culture. Fostering an environment that prioritises athlete health and wellbeing over mere performance metrics can transform how athletes approach nutrition and self-care. Advocacy for more comprehensive education about nutrition, energy balance, and mental health must be a priority among sporting bodies (15).

Coaches and trainers play a vital role in leading this cultural change; their understanding and support can empower athletes to prioritise their health and address RED-S proactively. By promoting open conversations regarding body image, nutrition, and mental wellbeing, the sports community can create an environment where athletes feel safe to seek help and guidance.

Regular workshops and seminars led by experts can provide updated information and resources to athletes, helping them equip themselves with the knowledge they need to combat RED-S effectively (16). Such initiatives will ensure that the next generation of athletes is better informed, healthier, and more resilient, paving the way for a brighter future in sports.

References

1. Mountjoy M, Sundgot-Borgen J, Møller R, et al. The IOC consensus statement on relative energy deficiency in sport (RED-S): 2014. Br J Sports Med. 2014;48(7):491-497.

   
   

2. Lundy B, White D, Miller K, et al. Disordered eating and eating disorders in female athletes: a systematic review and meta-analysis. Eat Behav. 2020;37:101384.

   
   

3. Tenforde AS, Campbell RK,, G. B. The role of a sports dietitian in the collegiate athlete's performance. J Int Soc Sports Nutr. 2015;12(1):49.

   
   

4. Melin A, Tornberg ÅB, Jorup C, et al. Low energy availability in some female athletes affects bone health. Scand J Med Sci Sports. 2013;23(6):627-635.

   
   

5. Hoch AZ, Hoch M, et al. Risk of injury among runners with a previous injury history within a running injury prevention programme. Int J Sports Phys Ther. 2019;14(1):51-58.

   
   

6. Papageorgiou M, Michalopoulou M, Panagiotou A. The psychological impact of relative energy deficiency in sport. J Sports Sci Med. 2021;20(1):125.

   
   

7. Pritchard M, Ryan K, J. J. The importance of a multidisciplinary approach to prevention of energy deficiency in athletes. Int J Sports Nutr Exerc Metab. 2015;25(2):227-238.

   
   

8. Zinkiewicz L, Shulman R, et al. Making sense of measures of energy availability: a preliminary approach. Eur J Sport Sci. 2018;18(7):904-912.

9. Thomas JJ, Vartanian LR, Brownell KD, et al.

   
   

10. Stigma and obesity: a review of the literature. Obesity (Silver Spring) . 2007;15(10):2422-2436.

    
    

10. The Female Athlete Triad Coalition. 2019 Consensus Statement on the Female Athlete Triad. Available from: <https://www.femaleathletetriad.org/consensus-statement>

11. Waldron M, McFarlane T, et al. Nutritional intervention as part of management of the female athlete triad. J Am Diet Assoc. 2015;115(5):1500-1504.

12. Treanor M, Carrard I, et al. A cognitive-behavioural model of eating disorders in male athletes. Eur Eat Disord Rev. 2019;27(5):515-520.

13. Haskell WL, Lee I-M, Pate RR, et al. Physical activity and public health: updated recommendation for adults from the American College of Sports Medicine and the American Heart Association. Circulation. 2007;116(9):1081-1093.

14. Breen E, Gibbons C, R. M. Osteopathy in the treatment of functional abdominal pain: a systematic review. SIJ Joint. 2017;2(1):38-48.

15. Martin T, Al-Amin M, R. H. Tackling the development of fatigue in high-performance athletes: classroom to community. Communications. 2020;55(3):485-494.

16. Hurst E, Wallechinsky M, B. J. Developing an educational programme to enhance nutrition knowledge among student-athletes. J Sports Nutr. 2020;15(3):142-150.