Achieving optimal performance is the goal of many athletes. However, there is a silent enemy that can undermine your efforts and even endanger your health: relative energy deficiency syndrome in sport (also known as RED-S). Those affected may be so focused on achieving their goals that they ignore warning signs.
As its name suggests, it appears as a result of a prolonged imbalance between food intake and energy expenditure. That is, the athlete does not consume enough calories to support the demands of his or her activity. This deficiency may be due to voluntary dietary restriction, insufficient intake or an increase in energy expenditure due to training.
Furthermore, RED-S affects all levels and disciplines: it can affect between 15% and 80% of practitioners depending on the sport modality.
The first red lights went on in 1992, when the concept of the female triad began to circulate. This label groups three interrelated disorders: eating disorders, irregular menstruation and bone loss. Later, the concept of low energy availability (LEA) emerged, and in 2014, the International Olympic Committee (IOC) recognized RED-S as a distinct clinical entity. Although it is linked to the LEA, its effects are more noticeable in the long term.
The latest consensus made by the IOC, which has just been published, offers a long list of health harms derived from RED-S. Among them are the following:
Sports performance also suffers with a reduced response to training, slower reaction time, low mood, lower muscle strength, decreased power…
And how can you avoid the “swipe” of RED-S? The latest research, also described in the IOC consensus, provides some clues:
Carbohydrate deficiency: the low availability of these nutrients accelerates the development of the syndrome, as it is associated with poor bone health or iron deficiency.
Excessive training: coincident symptoms have been detected between RED-S and overtraining syndrome. This occurs when there is no adequate recovery after intense and repetitive physical sessions. It can include fatigue, decreased performance and therefore susceptibility to injury. For example, it has been observed that training cyclists can improve parameters such as testosterone levels or aerobic capacity, but also worsen markers related to RED-S.
Temporal evolution: scientific evidence is still emerging and therefore its development process is largely unknown.
Mental health: Since this syndrome can also be related to concerns about weight and body image, psychological support is essential.
The priority is to reduce the behaviors associated with both the LEA and the RED-S. Educational initiatives to avoid obsession with body weight or thinness, especially in young and sub-elite athletes, are important in this regard.
Secondly, efforts must be redoubled to identify symptoms early with screening instruments such as interviews, questionnaires, evaluation of markers, etc.
And finally, clinical treatments will seek to rebalance the energy between the calories expended and the demands of the physical activity performed. To this end, modifications can be made to the training load and psychological assistance provided.
That both athletes and health professionals know RED-S well is key so that the first symptoms do not appear. Health must be the highest priority, so good care and a comprehensive approach will be essential to achieve sustainable success in sport.
This article was originally published on The Conversation
Daniel Sanjuán Sánchez is a physiotherapist and research faculty at the Faculty of Health Sciences and a member of the iPhysio research group at Universidad San Jorge.
