Having worked as a Physiotherapist for nearly 20 years, I have seen how both professional and amateur athletes can be affected by and susceptible to RED-S. I have clients who come from all different athletic backgrounds and so I think it’s worth noting that this can affect anyone. Runners, Triathletes, Gymnasts, Climbers, the list goes on!

Relative Energy Deficiency in Sport (RED-S) is a syndrome that can significantly impact the health and performance of athletes, particularly females. It arises from an imbalance between dietary energy intake and the energy expended in exercise, leading to insufficient energy availability for the body's needs. This article aims to provide a comprehensive understanding of RED-S, focusing on its symptoms, effects, and management strategies, specifically tailored for women who engage in regular exercise and are concerned about their health and performance.

What is RED-S?

RED-S is a broader, more comprehensive term that evolved from the concept of the Female Athlete Triad, which focused on three interrelated components: energy availability, menstrual function, and bone health. RED-S extends beyond these aspects, considering the wider spectrum of physiological functions affected by low energy availability, including metabolic rate, immunity, protein synthesis, cardiovascular health, and psychological well-being.

Symptoms of RED-S

Recognising the symptoms of RED-S is crucial for early intervention. Below is a checklist of symptoms that women athletes can use to self-assess:

• [ ] Unintentional weight loss or difficulty maintaining a healthy weight

• [ ] Irregular menstrual cycles or amenorrhea (absence of menstruation)

• [ ] Persistent fatigue and a noticeable decline in training performance

• [ ] Frequent illnesses or prolonged recovery from injuries

• [ ] Changes in mood, such as increased irritability or depression

• [ ] Difficulty concentrating or a decline in cognitive function

• [ ] Feeling cold more often than usual

• [ ] Changes in appetite or disordered eating patterns

• [ ] Decreased libido

• [ ] Poor sleep quality

If you tick several of these boxes, it is advisable to consult a healthcare professional for a comprehensive evaluation.

The Impact of RED-S on Health and Performance

RED-S can have far-reaching consequences on both health and athletic performance. The syndrome can lead to decreased muscle strength, increased injury risk, impaired judgement, and decreased coordination, directly affecting athletic performance. Health-wise, it can lead to hormonal imbalances, reduced bone density, compromised immune function, and cardiovascular risks.

The Psychological Aspect

The psychological impact of RED-S is significant. Athletes may experience anxiety, depression, and a distorted body image. These psychological factors can further exacerbate the energy deficiency by leading to disordered eating behaviours.

Risk Factors and Prevention

Certain factors increase the risk of developing RED-S, including high training volumes, certain sports that emphasise leanness (like gymnastics or distance running), and a lack of awareness about proper nutritional needs. Prevention strategies involve education on balanced diet, monitoring training loads, and fostering a supportive environment that prioritises athlete health over performance.

Management and Treatment

The primary goal in managing RED-S is restoring energy balance. This often involves a multidisciplinary approach including dietitians, physicians, and mental health professionals. Key strategies include:

- Adjusting energy intake: Increasing caloric intake to meet the energy demands of training and daily activities.

- Modifying training load: Reducing exercise intensity or volume to lower energy expenditure.

- Addressing psychological issues: Providing support for mental health and body image concerns.

- Monitoring health parameters: Regular check-ups to monitor bone health, menstrual function, and overall well-being.

Expanded Understanding of RED-S

RED-S is not just a condition affecting physical health; it encompasses a range of psychological and physiological issues. The energy deficiency at the heart of RED-S affects various bodily systems, leading to a cascade of changes. For instance, the endocrine system, responsible for hormone production and regulation, can be severely disrupted. This disruption can lead to irregular or absent menstrual cycles, a condition known as functional hypothalamic amenorrhea. This hormonal imbalance not only affects reproductive health but can also have long-term consequences on bone density, increasing the risk of osteoporosis and fractures.

Nutritional Aspects and Dietary Strategies

Nutrition plays a pivotal role in both the prevention and management of RED-S. A diet rich in nutrients, tailored to the specific energy demands of the athlete, is essential. This involves not only increasing caloric intake but also ensuring a balanced intake of carbohydrates, proteins, and fats, along with essential vitamins and minerals. Athletes, especially those in sports emphasizing leanness, often follow restrictive diets that can exacerbate the risk of RED-S. Therefore, working with a sports nutritionist is crucial to develop a diet plan that supports both health and performance goals.

Training Considerations

Athletes with RED-S often need to modify their training regimen. This modification is not just about reducing the volume or intensity of training but also about incorporating rest and recovery periods. Overtraining can exacerbate the energy deficit and worsen the symptoms of RED-S. Coaches and trainers should be aware of the signs of RED-S and work collaboratively with healthcare professionals to adjust training programs accordingly.

Mental Health and Support Systems

The role of mental health in RED-S cannot be overstated. Athletes suffering from RED-S may experience a range of emotional and psychological issues, including stress, anxiety, and depression. These issues can be both a cause and a consequence of RED-S. Access to mental health support, including counselling and therapy, is essential for athletes dealing with RED-S. Additionally, creating a supportive environment that focuses on health rather than just performance is crucial in both preventing and managing RED-S.

Long-Term Health Implications

The long-term health implications of RED-S can be severe. Apart from the immediate impact on athletic performance and physical health, RED-S can lead to chronic health issues. These include an increased risk of cardiovascular disease, impaired immune function, and long-term hormonal imbalances. Early detection and intervention are key to preventing these long-term consequences.

The Role of Healthcare Professionals as a team-based approach.

Managing RED-S requires a team approach involving various healthcare professionals. This team typically includes sports medicine doctors, dietitians, endocrinologists, psychologists, and physiotherapists. Regular monitoring and a personalised treatment plan are essential for recovery. This plan should address not only the physical aspects of RED-S but also the psychological and emotional factors.

Conclusion

In conclusion, RED-S is a complex condition that requires a comprehensive and multidisciplinary approach for effective management. Awareness and education about RED-S are crucial, especially among female athletes, coaches, and healthcare providers. Early recognition and intervention can help mitigate the risks associated with RED-S, allowing athletes to maintain both their health and their performance levels. If you think you may be suffering from RED-S then please speak to us at Quay Kinetics Physio in Exeter, or a healthcare professional who has experience in this area. Getting the right support and information can transform your health and well-being and allow you to reach your full potential.