We all get energy from food. The energy that we get from food (and most drinks) are called calories. Calories keeps us alive and give us the fuel for all activities – from breathing, to sleeping, to participating in sports… and so much more! Different bodies need different amounts of calories and the amount of calories a person needs depends on many factors.
No matter what these factors are, however, it is certain that we all need to be getting enough calories in order to be well. Relative energy deficiency in sport (commonly referred to as “RED-S”) is a term used to describe what happens when an athlete is taking in less energy than they need. This restriction may negatively impact their overall wellbeing as well as their performance in sport.
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Energy Needs in Sport
One of the factors that increases the amount of fuel that a person needs to be well is how active they are. Athletes and active individuals require a larger number of calories to fuel their bodies. RED-S may not be easy to detect in your child because it may not have obvious visible effects. In fact – you may find yourself, coaches, or your child saying “my performance is good so I must be healthy” or even “my performance is improving while living with RED-S so how can it be a bad thing?”.
In sports culture, it is sometimes thought that calorie restriction and period disturbances are simply a “part of the sport”. It is important to know that although RED-S is a complex syndrome that can feel confusing and scary — and may even feel necessary to some with a passion for their sport — it is NOT a requirement to be a great athlete.
RED-S Definition
RED-S is the female athlete triad new name. This term was used to describe what happens when a female athlete’s body was using more energy than they were consuming, which negatively affected their menstrual cycle and bone density. As experts in sports science and nutrition learned more, it became clear that this term was too limited.
Energy and nutrition is important for all athletes. Not taking in enough energy can cause problems with the menstrual cycle, bone density and all other bodily functions. Athletes who are assigned male at birth are also affected by not taking in enough energy – not taking in enough energy can be a problem for any athlete. It is important to remember that similar to eating disorders in children and youth, RED-S can occur in any body regardless of weight, size, or gender.
Signs and symptoms of RED-S can be found in 2-60% of male and female athletes across a range of sports. Although found in any sport, athletes at a higher risk of developing RED-S are those in sports that are judged with a focus on appearance, athletes in weight category sports, and endurance sport athletes.
Signs and symptoms of RED-S can be found in 2-60% of male and female athletes across a range of sports.
Symptoms of RED-S
Symptoms can be subtle, making it hard to spot and tricky to diagnose. You may notice some early signs of RED-S in your child which include:
- Weight loss
- Disordered eating patterns
- Lack of regular growth and development
- Frequent injuries (for example common stress fractures)
- Commonly getting sick, or staying sick for longer than normal
- Period disturbances (for those with a menstrual cycle)
- Mood/social behaviour changes
- Decreased performance
RED-S can go on to cause any combination of health problems for your child – both in sport and in their personal lives. It can be damaging to digestive health, immunity function, menstrual function (in those who can have a period) hormonal function, bone health, metabolism, heart health, mental health, and more.
Diagnosing RED-S
Your child may be diagnosed with RED-S based on the findings from many tests. These tests may be performed by a team of qualified medical professionals such as a physician, a psychotherapist, and a dietitian. These tests include a complete medical and sport history.
Your child’s eating habits and attitudes towards food will also be explored. Typically, a physical exam and specific blood and urine tests will be performed and interpreted by a trained healthcare professional. The results will determine whether or not your child has RED-S, and if so, what treatment options can be explored.
It is important to advocate for your child to receive a diagnosis as early as possible to reduce the chance of long-term health and performance consequences.
RED-S and Eating Disorders
RED-S is not an eating disorder, but there is often a strong relationship between eating disorders/disordered eating and RED-S.
Athletes have been found to have higher rates of eating disorders and disordered eating than the general population – up to 19% of males and 45% of female athletes have an eating disorder or disordered eating. Considering that RED-S is caused by not consuming enough energy for one’s activity level, eating disorders and disordered eating where food is restricted may lead to a diagnosis of RED-S. Folks living with RED-S may also develop an eating disorder as a complication.
Although there is a link between a diagnosis of RED-S and eating disorders, not every athlete with RED-S has an eating disorder. There are instances where athletes unintentionally take in too little energy for their needs. This could be due to increased training, not having the time, skills, knowledge, or resources to prepare or eat the amounts of food that they need, or they may not know what their energy needs are. The treatment plan will be different for an athlete with an eating disorder compared to an athlete who is not eating enough food for other reasons.
Treating RED-S
With the help of a qualified healthcare team, many of the complications of RED-S can be reversed. Treatment often involves increasing energy intake and/or decreasing the duration, intensity, or frequency of training sessions. For some, overcoming RED-S can be achieved through sport nutrition education. For others, treatment will require eating disorder recovery approaches.
Possible Complications of RED-S
Depending on the severity of RED-S, some complications are less likely to be reversible. A low bone mineral density, for example, cannot be reversed but can be improved with treatment. Identifying and seeking treatment for RED-S is strongly encouraged to make sure your child has the best chances of recovery.
How Can I Get Help for My Child?
Overcoming RED-S requires a team-based approach. The expert dietitian nutritionists and therapists here at Change Creates Change are ready to help if you need us. If you would like to learn more about how we can help, click below to book a free 15 minute consultation call with us.
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