Athletes are dedicated to achieving high performance and excelling in their sport, both individually and as part of a team. Their training to improve physical performance puts significant demands on their bodies, physically and mentally. If athletes push themselves too hard, there is the possibility of developing RED-S Syndrome.
What is RED-S Syndrome?
Relative energy deficiency in sport, or RED-S Syndrome, is a physical condition in which there is a mismatch of energy intake and expenditure in a person’s body. There are varying degrees of RED-S. On the lower end of RED-S, there is low-energy availability due to overtraining. An athlete may not be able to move as fast or as long. On the higher end of RED-S, the energy expenditure imbalance is not meeting the body’s needs and physiological changes begin to happen. Disordered eating can be the cause of low energy. Hormones are affected by the energy imbalance, which can affect the athlete’s bone health. Females can even develop amenorrhea (absence of menstruation).
RED-S affects men and women and can extend beyond athletes to anyone who is working out a lot or training extensively. Some signs of RED-S include injuries, stress fractures, decreased performance, delayed recovery and depression.
Long-Term Consequences of RED-S
During RED-S, the body undergoes numerous hormonal changes. The lack of sufficient energy affects the hypothalamus (in the brain) and pituitary gland, leading to reduced production of estrogen and progesterone. This can result in irregular or absent menses (blood and other matter discharged during menstruation), as well as decreased bone density. Estrogen plays a crucial role in bone health, particularly during adolescence and the early 20s when bones are still developing. If bone density is not built during this period or if it's being lost, the risk of developing osteoporosis later in life is significantly increased. Moreover, men are also impacted by thyroid changes, leading to a decrease in testosterone production, which can in turn affect bone mineral density.
The physical changes in the body are accompanied by psychological effects. The body releases more stress hormones, which can lead to anxiety and depression. This can exacerbate the frustration of not being able to exercise well or being injured, ultimately leading to sitting out from the sport.
When an athlete is significantly imbalanced due to RED-S, the risk of injury increases. In severe cases, the body, in desperate need of energy, begins to metabolize muscle tissue. The more malnourished a person is, the more the body breaks down muscle, including the heart muscle, which can lead to heart problems. This underscores the critical importance of balanced nutrition and care for overall health and well-being.
High-Risk Activities
Athletes who are most at risk for RED-S often participate in aesthetic sports like dance and gymnastics, where maintaining a slim and slender appearance is highly emphasized. This pressure can be challenging to navigate. Similarly, athletes in high-endurance sports such as marathons and ultramarathons are also at risk due to the intense metabolic demands these activities place on their bodies. It's essential for these athletes to balance their energy intake and output to support their health and performance.
Prevention
Raising awareness is essential to prevent athletes from developing RED-S. Coaches and teammates should avoid emphasizing a slim and slender appearance and instead focus on promoting healthy behaviors, such as consuming a balanced diet rich in protein and vegetables. By encouraging these positive habits and valuing health over physical appearance, we can support athletes in maintaining their well-being and achieving their best performance.
Athletes can thrive by following thoughtful dietary recommendations. Protein intake should generally be one gram per kilogram of body weight, though this may need to be higher depending on the sport. A colorful variety of vegetables is essential, providing vital nutrients for overall health. And remember – carbohydrates are essential. They offer the essential fuel that breaks down into quick energy, keeping individuals vibrant and ready to perform at their peak.
How to Avoid RED-S
Athletes can strive for a balance between overexerting themselves to achieve superior performance and listening to their body when it sends messages. Athletes often "push through" in order to become mentally tough to deal with pain, but it’s important to respect your body, understand its signals and not push too hard to make sure there’s an even trade-off between athletic success now and the impact on long-term health.
Rely on Resources
Coaches, physical trainers, nutritionists and physicians are pivotal in preventing and managing RED-S. They interact closely with athletes, address injuries and can raise awareness among parents of teenagers. Through education and resource sharing, this group can effectively help prevent or detect RED-S at an early stage.
Endeavor Health provides support and guidance in sports medicine for athletes and active individuals, aiming to help them live healthy and fulfilling lives. You can reach out to our network of orthopedic physicians specializing in treating injuries and conditions. Visit us online or call (847) 570-2570.
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