RED-S: The reason for your athlete’s struggles?

RED-S: Is it the reason for your athlete’s struggles?

I know I’m talking a lot about underfueling lately. But, with what I know and all I’ve seen in the last couple of years, I feel like I would be doing my followers, clients and athletes a true disservice if I glossed over the topic or, worse, didn’t address it at all.

So, today I’m going to spend time giving you a surface-level overview on a relatively new medical condition known as Relative Energy Deficiency in Sport, also known as RED-S. 

I talk about this condition ALL THE TIME whether I’m in clinic or speaking in schools or speaking at a conference. I can speak in depth on this topic for 30 to 45 minutes if given the time but this post is just to give you an introduction to this important-to-know-about condition so it will be much more brief. So, today I hope to hit the high points on this important condition called RED-S.

BEFORE THERE WAS RED-S

Researchers have been studying underfueling, or as I explained in my last post, Low Energy Availability (LEA), for a long time. 

Lea in Females

Initially this occurrence of LEA was associated with females in what was termed the Female Athlete Triad. The Female Athlete Triad  is a medical condition in which a female athlete experiences one of the following: 

1. Compromised bone health

2. Irregular menstrual cycle

3. Underfueling (intentional or unintentional)

lea in Males

As researchers and clinicians continued to look into underfueling and its effects on athletes, their health and their performance they found that a similar condition to the Female Athlete Triad with similar consequences could present itself in males as well. And so a condition in male athletes was established called the Male Athlete Triad. 

In males the condition could manifest in several ways, very similar to females:

1. Compromised bone health

2. Altered hormone levels and cycles (testosterone levels, etc.)

3. Underfueling (intentional or unintentional)

In both Female Athlete & Male Athlete Triad…

Not all components have to be present to be diagnosed by a physician. It might be that the athlete only exhibits one. However, if one component is present, it is very likely that others are present as well and so further examination into the others is recommended. From my practice, I see that the root cause is the underfueling. And from there, if not noticed and managed leads to what we see and the athlete experiences - the bone injuries and / or the hormone changes. lost periods, etc.

In practice…

I typically come in when a female athlete has:

• lost her period for 3 months or more or 

• has experienced one or more stress fractures or

• when an athlete has exhibited some significant weight loss or a weight plateau in the last few months to years, causing her to start falling off her growth chart.

I’ve found that for some female athletes it takes a small amount of underfueling and for others it takes extreme underfueling for their menstrual cycle to be disrupted. But, just because a female athlete still has her period, it does not mean she is for sure fueling enough and appropriately. Just something to keep in mind.

I typically come in when male athletes have:

• had one or more stress injuries in the last year

• had altered labs at their last pediatrician visit  or 

• H=had recent weight loss or a weight plateau, causing them to start falling off their growth chart.

DISCOVERING RED-S

Researchers and clinicians were aware of the Female and Male Athlete Triad but continued to study the effects of underfueling and LEA (and we’re still studying LEA today).

the effects of underfueling and LEA can reach beyond decreased bone health, hormone regulation, and menstrual dysfunction

As they studied athletes and underfueling they started to see that the effects of underfueling and LEA can reach beyond decreased bone health, hormone regulation, and menstrual dysfunction. It can actually have a much wider scope of impact on the athlete’s health and performance. Underfueling can impact an athlete’s:

• mental health (seen or felt as increased anxiety for example), 

• cardiovascular health (ex: slowed heart rate as the body tries to preserve energy)

• metabolism

• gastrointestinal health

• immune system

• endocrine system

• haematological (iron deficiency anyone?)

• growth & development

DETECTING RED-S

Putting this into practice, some examples of when I would look further into RED-S and check an athlete’s fueling would be:

• A typical non-anxious athlete begins to struggle with anxiety.

• An athlete already diagnosed with anxiety has been feeling heightened anxiety lately.

• The pediatrician or other medical professional has observed a very low heart rate.

• The athlete has started complaining of GI issues like constipation or feeling like it takes a long time to digest food.  Maybe they just don’t get hungry anymore.

• The athlete is constantly getting sick or it’s taking a long time to recover.

• The athlete has experienced an injury and it’s taking a longer than expected amount of time to heal and recover.

• There are delays in growth and development. This could look like the athlete’s weight and height plateauing or falling off their growth curve. It could look like a 16 year old female athlete still not every having had a period.

• The athlete is complaining of extreme fatigue with exercise, weak muscles, hitting a wall. Labs come back from the pediatrician and patient has low iron levels.

• The athlete gets hormone labs at their well-check visit or another visit and they find low and altered levels of specific hormones.

what next?

Now, it’s important to take into account that there could be something very clinical going on and these complications have nothing to do with nutrition, so of course get it checked out by the appropriate specialist.  

BUT, at the same time, if there has been any change in the athlete’s training or the athlete’s intake, it may benefit the athlete to look at their fueling. Are they getting ENOUGH fuel each day? And then, are they getting enough of the best foods for them within those fuel choices? 

In practice…

Similar to what I included above, athletes with suspected RED-S typically show up in my office when:

• A female athlete has lost her period for 3 months or more

• A 15 or 16 year old competitive female athlete has not yet started her period

• An athlete has experienced one or more stress fractures

• An athlete has exhibited some significant weight loss or a weight plateau in the last few months to years, causing them to start falling off their growth chart.

• The athlete is experiencing repeated injuries or illness

• The athlete has had a sudden change in intake and food preferences

• The athlete has received altered nutrition labs like iron levels from the pediatrician or other markers that may indicate dehydration or altered nutrition intake

Sometimes taking a look at the athlete’s fueling plan and giving it a boost AND BEING CONSISTENT with these changes, can improve digestion, can help the athlete with their anxiety, can decrease illness and can allow appropriate, necessary and needed weight gain so the athlete can continue to reach their height potential and get through puberty.   

What I’m talking about today is something I see in my practice all the time. It’s also all found in the scientific literature. I’m linking a resource below in case any of you like to get really into the details and the science (like I do 🙂).

Resource for more reading:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9724109/pdf/nihms-1853616.pdf

And here’s a great graphic that explains RED-S by Keay & Rankin…

And, if you think your athlete could benefit from improved fueling, you can download my free Getting Started Guide HERE!

Until next time!

Much love and a well-fueled athlete,

Taylor

When Your Athlete Is Skipping School Lunch

Ok, guys. I feel like today’s post is a big one, skipping school lunch. So many athletes that come to see me skip school lunch! So. Many.  Maybe they don’t skip every day but they probably skip at least a couple of days a week in the school week. If that is your athlete, then today’s post is for you and feel free to pass this along to your young athlete 🙂.

Today I’m going to discuss (1) why skipping lunch is counterproductive or even harmful to a young athlete’s health and performance, (2) some reasons your athlete may skip lunch (that I have seen most often in my practice), and, then, (3) how we can help our athletes fuel better when they are accustomed to skipping lunch. I hope you find this helpful as we enter a new school year!

Why Skipping School Lunch Is counterproductive or Harmful to a Young Athlete’s Health & Sport Performance:

In many ways kids and teens are resilient.  We know they tend to bounce back faster after illness or injury than adults.  However, nutrition, or I should really say, a lack of proper consistent nutrition, in my pediatric nutrition experience, is not something that their bodies are more resilient with.  Why is this?  It is because:

• Their young bodies may only be able to utilize a certain amount of a nutrient at once, a lesser amount than an adult body. An example would be protein. 40 grams of protein at a meal / snack is not going to be as beneficial for a 13 year old soccer player as it would be for a 27 year old professional soccer player or 45 year old non-athlete.  At that young age the body will use roughly 20 maybe 30 grams of consumed protein to build / maintain muscle. It may use additional protein for other needs of the body but not to build muscle. And the rest may be stored or broken down and gotten rid of by the body.

So, with this being said, why then is skipping the lunchtime meal and often going most of the school day without eating, counterproductive or harmful to a young athlete’s health & sport performance? It is counterproductive because…

1. This extremely long period of time without fueling the body can cause the body to use protein for fuel (ie, break down muscle) because carbohydrate stores have been depleted. This can hinder goals of improved strength and muscle gain.

2. This extremely long period of time without fueling the body puts the athlete at risk of dizziness, fatigue and fainting during practices due to his/her brain and muscles being depleted of energy (in an energy deficit). This can of course lead to possible injury and certainly decreased performance during games and competition. I always say, “If you want to play or perform your best then you have to show up to practice your best”.

3. This extremely long period of time without fueling the body specifically after a practice (for example: an intense morning practice followed by nothing to eat, maybe some goldfish or chips until school gets out that afternoon) can hinder improvements in strength, power or technique because the athlete has failed to consume any recovery fuel to support replenishment of energy (carb) stores, building/rebuilding of muscle (protein) and hydration of the body.

4. On a more health-related note, we all want balanced blood sugars. Getting that mid-day meal helps balance blood sugars. Low blood sugars can cause someone to feel lightheaded and dizzy, it can make it hard to concentrate and it can enhance feelings of anxiety.  So, not only does it help with performance, but eating consistently throughout the day can also be helpful in managing anxiety as well as supporting academic performance.

Most young athletes that I see are (a) trying to improve performance (b) working on recovering from an injury or (c) trying to build lean muscle.  Skipping lunch and going from 7:30 am (breakfast that the athlete is hopefully eating) to about 3:00pm (after school snack), that’s almost 8 hours, is hindering each of the above goals. While some athletes may at least grab a snack, I remind them that having a small bag of pretzles or chips is not sufficient. A missed meal is a missed chance to fuel the brain and the body for a later practice or to help recover the body after an earlier practice and eating a meal twice as big at the end of the day is not going to make up for it. 

4 Potential Reasons Your Athlete Is Skipping School Lunch:

1. They say they don’t have enough time. 

2. They don’t like the food served in the cafeteria.

3. They would rather study, finish an assignment or hang out with their friends during lunch.

4. They are struggling with disordered eating behaviors that limits their ability or desire to eat during lunch.

4 Ways to Fuel Through Lunch / the School Day:

1. They say they don’t have enough time. 

• Trying several hearty, sport-supporitng snacks throughout the day during lunch and between classes.

• I remind athletes, “If you want to be a great athlete, play in college, get the scholarship, etc. you have to do the work and that includes EATING. Eating is just as important as practice, conditioning, cross-training and sleep!

2. They don’t like the food served in the cafeteria.

• If you are able, it’s time to start packing a lunch that the athlete gets to help plan. They can eat school lunch or they can eat a lunch from home, or, in some cases, they can have a bunch of larger snacks throughout the day in place of the one meal, but not eating is not an option. And there is nothing wrong with the classic BP&J!

3. They would rather study, finish an assignment or hang out with their friends during lunch.

• This would be a great reason to start packing a lunch. And pack foods that are easy and convenient to eat while studying, working on an assignment or hanging out with friends. Ideas include: cheese sticks, turkey slices, Greek yogurts, whole grain granola bars, grapes, apple slices, carrot sticks with hummus, homemade trailmix (with cereal, nuts, seeds, dried fruit), milk/chocolate milk, and popcorn.

4. They are struggling with disordered eating behaviors that limits their ability or desire to eat during lunch.

• I am not going to go too much into this topic today because it really is it’s own series of posts for another day. But if your athlete is struggling to eat lunch because of disordered eating thoughts, I highly encourage you to find a dietitian specializing in eating disorders and connect with a counselor that specializes in eating disorders quickly. This is a hard block and can take time to work through.

If your athlete is struggling with eating lunch at school, I hope this post has given you some points of discussion when chatting with your athlete as well as some ideas to break the barrier and start getting your athlete fueled through his/her school day.

Need help fueling your athlete this fall? You can follow me on Instagram at @taylormorrisonRD for more info and tips or you can reach out to me to schedule a call and see if working together would be a good idea!

Happy Fueling!

Taylor