What is RED-S and is your athlete at risk?
RED-S stands for relative energy deficiency in sport and has replaced the female athlete triad in concerns for athletes. Athletes are at risk for RED-S when they have insufficient fuel for exercise and life function. The result is the body abandoning certain system functions in order to direct all energy to vital system functions. Fatigue, decreased training response, decreased endurance performance, decreased muscle strength, decreased concentration, impaired judgment, depression, anxiety, irritability, and an irregular or lack of menstrual cycle.
RED-S disrupts many body systems and can cause permanent damage if it’s not caught early. RED-S is highly destructive to the endocrine system and disrupts hormones that are instrumental for growth, repair, and reproduction. Changes in estrogen, testosterone, leptin, IGF-1, growth hormone, cortisol, thyroid hormone, and insulin levels affect metabolism, bone health, and cognition. As energy deficiency progresses a body will lose its ability to correctly secrete or inhibit these hormones resulting in reproductive system damage, inability to build and maintain bone tissue, inability to utilize glycogen stores, chronic storage of energy, inability to maintain lean tissue mass, and prolonged time to recover from injury.
Due to the severity of RED-S, it is best to educate your athletes on how to avoid this perilous situation. Athletes need to know how food fuels their bodies and enhances their performance in order to value food and not be willing to reduce their intake to the point of RED-S. Education should also be extended to family members who are influential in the athlete’s life. Understanding what is at risk of RED-S looks like and understanding what causes an athlete to get to that point is imperative. Help athletes understand that they need to obtain sufficient daily calories from FOOD. Educate them on their need to obtain sufficient amounts of ALL macronutrients: protein, carbohydrate, fat, and water. Help them visualize the difference that eating a variety of foods makes for their micronutrient needs by walking them through “eating a rainbow every day”. Clearly explain the necessity of fueling their bodies before and immediately after training. Finally, communicate to female athletes that they need to be having a regular menstrual cycle. If you are unclear on any of these points, educate yourself first before you try to educate others.
If you have an athlete you are concerned about, begin documenting the observed signs/symptoms that are concerning. Speak with the athlete (or athlete’s parents if a youth) stating that the observed signs/symptoms that you’ve documented are consistent with being at risk of RED-S. Be sure to communicate this in a way that preserves the athlete’s dignity while also addressing concerns as early as possible. Recognize your own limitations and scope of practice, and advise the athlete to consult a sports med physician or their primary care doctor. Respect their autonomy and understand it is their decision to seek help. Continue providing good nutrition information and support.
A good way to begin the conversation with an athlete you’re concerned about is:
Express concern for their health and well-being
Encourage them to seek medical attention and offer to help them find someone who specializes in sports nutrition or sports medicine.
Emphasize the importance of food as fuel and that eating a balanced diet is essential for optimal performance.
Be cognizant that recovery takes time and be willing to make adjustments.
Emphasize and re-emphasize that the athlete’s health and well-being are the top priority and that their long-term success depends on maintaining a healthy and sustainable approach to training and competition.
What you should not say:
Any language that may be perceived as shaming or judgmental such as, “You need to eat more” or “You’re not eating enough”.
Don’t assume that the athlete’s behavior is intentional, disordered eating and RED-S are complex and multifactorial issues.
Don’t make assumptions about the athlete’s motivations or goals or accuse them of mismanaging their bodies.
Continued Support:
Be available and encourage the athlete to talk openly and honestly about their experiences and LISTEN.
Be supportive and empathetic, and avoid pressuring them or making them feel guilty or ashamed.
Help the athlete to identify and challenge negative thoughts and beliefs about food, weight, and performance.
Encourage them to seek help.