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Relative Energy Deficits in Sport (RED-S)

By 1 October 2018December 30th, 2020No Comments

By WIN Contributor: Dr. Matthew Bird, Chiropractor

Over the past couple of months, I have fielded questions related to training load and how much is appropriate for optimizing performance. This topic isn’t so cut and dry as it must consider individuals based on their gender, age, sport, nutrition, genetics, psychological factors, etc.

Relative Energy Deficits in sport was formally known as the female athlete triad but, was recently updated as it can affect all athletes of any age or sex. Simply put, RED-S becomes an issue when the energy supply is less than ideal with an increasing training schedule. This will then lead to a deficit in the overall balance of energy coming in (food) and energy exerted (sport/training).

This imbalance can lead to detrimental effects on:

  • Bone health

  • Menstrual function (in women)

  • Immune function

  • Endocrine function

  • Cardiovascular health

  • Muscle health

  • Psychological health

The signs and symptoms of RED-S are not so clear because many of the issues occur in the background without an athlete knowing.

Here are a couple of things to consider when assessing your training schedule as it relates to adequate intake relative to output:

1)     The only obvious sign of RED-S pertains to the female athlete is loss of menstruation. No matter the situation, this is a red flag. A loss of an athlete’s menstrual cycle signifies a good chance that the athlete is also experiencing potential bone loss and/or weakness leading to higher risks of stress fractures and/or actual fractures. Overall weight of an athlete is misleading as it does not just occur in females of low weight. Further complicating the issue is the use of birth control because it may give the elusion that everything appears normal.

2)     Reoccurring injuries and/or stubborn muscle/tendon/ligament pains. If overall mobility and daily function appear normal with no obvious pathological signs, then RED-S may be the issue.

3)     Chasing the ideal body type/image. This varies between sports as the ideal body may differ based on the sport alone. Unfortunately, there is a presumption in sport that a certain body type will lead to improved performance. In sports that require athletes to make weight, athletes will experience a negative impact on performance because of the energy deficit needed to cut weight.

4)     Co-ordination, impaired judgement, irritability, and depression are common signs of over training on reduced caloric intake. Impaired muscle health may be evident in an athlete’s co-ordination during a training session. If your chosen sport is based on endurance (running, biking, rowing, etc.), a coach may notice deficiencies in athletic form. Again, this may lead to the issue of lingering aches and pains without obvious signs of injury which may cause behavioural changes in the athlete.

5)     Is there adequate rest between training sessions? Rest is where the body undergoes repair processes and generally occurs through the night during sleep. Sleep disruption limits tissue repair which contributes to chronic aches and pain. Our bodies generally follow a circadian rhythm with the release of growth hormones and the removal of corticosteroids. Therefore, if you are an athlete that works shift work, careful planning of rest is critical as you want to prevent training while feeling exhausted. It is okay to take a day off during training.

For coaches and/or trainers, this becomes a tricky topic to monitor. Open communication is critical to maintain the longevity of your athletes. For the individual who seeks out personal growth and development and does not readily have a coach to discuss performance, take note that increases in training sessions should correspond with increases in caloric intake. This can be an extra snack throughout the day and/or a change in meal prep strategies to balance carbohydrate, protein, and fat intake.

We all believe we do the right thing when it comes to nutrition and training but, if you feel like discussing possible options to overcome the hurdles of performance, WIN Health Solutions has a comprehensive team of practitioners to support you and to help make you better today than you were yesterday.

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