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

Is Your Athlete Underfueling? A Common Oversight

Is Your Athlete Underfueling?

Many of my posts have an underlying theme of underfueling but I realized I have not created a post specifically devoted to this topic. So, that’s what I’m going to take a few minutes to talk about today.

If you have been following along with me on Instagram lately, or in my Newsletters, then you have seen me talk about this topic. It has been the most asked for topic that coaches and athletic trainers have asked me to come speak on in this last year. And it is one of the top two reasons athletes have come to see me in clinic since the beginning of 2023 (with probably the other one being helping them navigate nutrition in their recovery, like from an ACL tear and repair).

Going into the field of sports nutrition and then, more specifically, pediatrics I didn’t think this is what I would spend the majority of time talking about. Although, it should not surprise me because for a time in my childhood I was absolutely another underfueled young athlete - even when I improved my fueling significantly, I was still underfueling. And I didn’t realize that part until I got into this field as an adult, started working with young athletes, and studying the field. So, I know how easy it is to say, “no, my fueling is good. It’s so much better than a year ago. There must be another reason for (xyz). Or, I’m doing well so my fueling must be optimal now”. 

If the young athlete is experiencing any of the signs or symptoms I’m about to mention, then they and their support team really need to take a closer look into their fueling. Improved food and energy intake can have a huge impact on performance, helping the athlete achieve the muscle gains they have been working on, it can improve endurance and speed, it can improve mental focus and, a big point, it can keep your athlete in the game and away from nutrition-related injuries that can have them out of their sport for months. From a health perspective, being well-fueled can improve the athlete’s mood, help keep anxiety down, promote heart health, metabolic health, and bone health. 

Maybe you are the athlete or have the athlete who has experienced some of the signs and symptoms below but they are still performing and practicing well. My thoughts to that are... 

“Ok, great. So you’re performing well off of minimal fuel. But, for how long? And, if you can perform well off not enough, JUST IMAGINE what you could do, how you could perform, the levels you could get to if you were fueling WELL. If you were fuleing your BEST. If you are talented and driven and scrappy enough to perform well off of too little fuel or the bare minimum, just think about what your body could do if it had all that it needed!! Imagine what it could do if it didn’t have to power down or compromise different systems so you could practice and perform?

I’m so passionate about this, clearly. And I get SO EXCITED when I see athlete’s performance improve with improved fueling. It could be small changes it could be big changes, but it makes a difference and I love to see this “click” in the young athletes I work with.

This is not just me talking about fueling and how important it is. This concept of underfueling has actually been studied and continues to be studied in great detail. From it has developed a term call Low Energy Availability, meaning the athlete does not have enough energy available at the end of the day each day to perform all of the functions demanded of it (think - exercise, studying, growth, development, breathing, eating, heartbeat, hormone cycles, etc.). Another way I like to explain this is that “if you have been underfuling consistently for a long period of time, you are likely in a state of Low Energy Availability (LEA)”. It can be intentional or it can be unintentional, but either way it means that some function of the body is very likely getting powered down or compromised (think loss of menstrual cycle in females, sluggish performance, fatigue, lowered heart rate, etc.) and can lead to decreased performance and injury.

Further research shows us that Low Energy Availability is often the root cause of a few other medical conditions now recognized in athletes.

These medical conditions stemming from LEA are:

• Relative Energy Deficiency in Sport (RED-S)

• Female Athlete Triad

• Male Athlete Triad

I’m not going to go into detail about these today, but will instead devote a separate blog post to each topic. They all can lead to decreased performance, health problems or injury, none of which we want in our young athletes! In future posts I also want to talk more about potential reasons for underfueling - intentional vs unintentional. The reason the athlete is underfueling can have a big impact on how we help them get fueled and the projected timeline of return to optimal fueling (or return to sport).

So, I’ll leave you today with a handful of the signs and symptoms of underfueling. Is your athlete experiencing any of these? If so, it’s likely time to start looking into their fueling habits and create a plan. And, definitely stick around for future posts where I go a little deeper and provide insight into these medical conditions caused by underfuleing.

Signs and Symptoms of Underfueling:

• Dizziness

• Fatigue

• Weight Loss

• Hair Loss

• Growth Disturbances (athlete stops gaining in height)

• Unable to build muscle

• Lost period or not starting period by age of 16

• Heightened anxiety and/or moodiness

• Low iron levels / iron deficiency

• Low heart rate (but must distinguish between underfuling and lower heart rate that elite athletes tend to have)

Much love and a well-fueled young athlete,

Taylor

Oh, and if you’re looking for a little more direction and a place to start taking action, you are welcome to download my free Getting Started to a Well-Fueled Young Athlete!