Relative Energy Deficiency (RED-S) in female athletes?

Female athletes often find themselves under pressure to perform and may experience periods of overtraining, under-fuelling, or dieting.

This may be in pursuit of looking thinner, being lighter or faster. Although perhaps well-meaning, or even unintentional, these actions can lead to reduced performance, and more importantly can be damaging to their health.

These conditions are a clinical syndrome known as “Relative energy deficiency in sport”, formerly known as the “female athlete triad”.

Signs of RED-S in females may be:

· Irregular of loss of periods (called amenorrhea)

· Low BMI (18.5kg/m2 or less) or weight loss

· Stress fractures, broken bones, or other sports related injuries (osteoporosis)

Why does this happen?

When energy expenditure from physical activity exceeds calorie and nutrient intake from food, the body must ‘choose’ which functions to prioritise. It uses the energy it does have for the most important functions – like breathing, thinking and pumping the heart, and stops providing energy for less crucial functions like menstruation.

Not getting a period may not seem like a big deal, but this hormonal disruption can have long lasting consequences.

For example, bone health is dependent on a delicate hormonal balance. As a result low oestrogen levels, inadequate nutrition and low calcium and vitamin D intake may lead to bone loss. This process can result in stress fractures which can not only affect performance, but can lead to long lasting damage and risk of future injuries, as well as impair growth and development. This is especially dangerous for young athletes who are still growing. So, although there may be an initial increase in sport performance if left untreated, this may lead to serious consequences.

How is RED-S diagnosed?

Although there is no specific test to diagnose this condition, a doctor may order blood tests, perform an electrocardiogram (to identify any irregular heartbeats) or do a bone-density scan known as a DXA scan. You may also be asked a series of questions relating to the signs and symptoms of RED-S from your Sports Dietitian through a LEAF-Q questionnaire and other questionnaires that are available , and so they may ask about your period, stress fractures and injuries, your current weight and weight history and your diet and exercise patterns.

As there are complex factors which interplay in this condition, there may be a team of healthcare professionals involved in the treatment plan. For example, a doctor, dietitian, psychology, physiotherapist or training coach may be involved in the care. They will focus on:

· increasing energy intake

· reducing physical activity levels

· and restoring low nutrient levels e.g. calcium and vitamin D

To avoid the risk of developing RED-S it is important to listen to your body.

Pause and consider if you’re regularly feeling hungry, run-down, fatigued or get frequent injuries. Remember to take time to rest as recovery is an important process, for everyone!

Reassess your energy intake and your exercise routine - are you eating enough in relation to how much you exercise?

Keep track of your periods, your mood and how your body feels.

If you are concerned about any of these symptoms for yourself, or for someone else, please do not ignore these signs.

Speak to your GP or registered Sport Dietitian who can help. At Nutrition and Co, we have UK’s best sports nutritionist / sports dietitian, Jenaed Brodell and her team of sports dietitians who do 1-1 online nutrition consultations.

Written by Megan Mehnert at Root Source Nutrition

References

Bean, A 2009, Complete Guide to Sports Nutrition, A & C Black, London, GBR. Available from: ProQuest Ebook Central. [18 August 2022].

https://kidshealth.org/en/teens/triad.html

https://orthoinfo.aaos.org/en/diseases--conditions/female-athlete-triad-problems-caused-by-extreme-exercise-and-dieting/

https://www.relentlessathleticsllc.com/education/2018/10/the-female-athlete-and-the-menstrual-cycle

Keay, N. & Rankin, A. 2019, "Infographic. Relative energy deficiency in sport: an infographic guide", British journal of sports medicine, vol. 53, no. 20, pp. 1307