Relative Energy Deficiency in Sport (RED-S)
Article of interest!! Relative Energy Deficiency in Sport (RED-S) is rightfully, gaining more and more attention. The incidence of RED-S has become increasingly prevalent in elite athletes and recreational exercisers alike. Clinically, we are treating more patients presenting with injuries and poor bone health as a result of low energy availability.
The International Olympic Committee (IOC) published a consensus statement entitled “Beyond the Female Athlete Triad: Relative Energy Deficiency in Sport (RED-S)”. The syndrome of RED-S refers to: “impaired physiological functioning caused by relative energy deficiency, and includes but is not limited to impairments of metabolic rate, menstrual function, bone health, immunity, protein synthesis, and cardiovascular health.” The aetiological factor of this syndrome is low energy availability (LEA) and shown in the figures below (Mountjoy et al., 2014).
Figure 1. Health Consequence of Relative Energy Deficiency in Sport (RED-S) showing an expanded concept of the Female Ath- lete Triad to acknowledge a wider range of outcomes and the application to male athletes (*Psychological consequences can either precede RED-S or be the results of RED-S).
Figure 2. Potential Performance Effects of Relative Energy Deficiency in Sport (RED-S) (*Aerobic and anaerobic performance)
RED-S, is a mismatch between an athlete’s energy intake (diet) and the energy expended in exercise, leaving inadequate energy to support the functions required by the body to maintain optimal health and performance. Operationally, energy availability (EA) is defined as:
Energy Availability (EA) = [Energy intake (EI) (kcal) – Exercise Energy Expenditure (EEE) (kcal)]/ Fat-free mass (FFM) (kg)
Where exercise energy expenditure is calculated as the additional energy expended above that of daily living during the exercise bout, and the overall result is expressed relative to FFM, reflecting the body’s most metabolically active tissues.
Personally, I feel this area is still not getting enough attention, specifically within recreational athlete/exercise enthusiast community. Clinically, we are seeing an increased numbers of cases. This has been exacerbated by COVID-19 lockdowns, with more and more people increases their activity levels, particularly through running. We have seen many individuals, go from fairly sedentary to running more than 2hrs everyday, without a day off. Additionally, they have not increased their energy intake to match these demands.
Greater awareness and education is needed to address this issue and help to mitigate injuries and the associated negative impact of RED-S to health.
In this review article, @markhutson et al., evaluate the effects of low energy availability on bone health in endurance athletes and explore whether a high-impact exercise intervention may help to prevent those effects from occurring.
Click on abstract for full text
