Did you know that not eating enough can negatively impact your sport performance as well as harm your overall health and wellbeing?
What is Relative Energy Deficiency in Sport?
Formally known as the ‘Female Athlete Triad’, Relative Energy Deficiency in Sport (REDs) is a clinically diagnosed condition that is caused by a mismatch between the amount of calories consumed and energy burned through exercise. This leaves the body with not energy to support essential body functions required to maintain optimal health, function, and performance.
REDs is characterized by impairments in physiological and psychological functioning, including negatively impacting metabolism, reproductive function, bone health, digestive function, the immune system, cardiovascular health, mood, and sleep (Mountjoy et al, 2023). It has also been shown to negatively impact performance. This includes decreased muscle strength and power, decreased endurance performance including reducing VO2max, decreased reaction time, coordination and concentration, impaired recovery, reduced glycogen synthesis, and increased risk of injury and illness, impacting ability to train (Mountjoy et al, 2023).
Our bodies are designed to cope with periods of changing intake and energy expenditure. However, when the lack of energy available to the body is severe or it occurs for a prolonged period of time, the risk of developing REDs increases.
Who is at risk for developing Relative Energy Deficiency in Sport?
REDs can affect athletes of any gender in any sport and at any age. Risk factors include:
- decreased dietary intake
- increased exercise energy expenditure
- desire for weight loss
- disordered eating/training behavior
- sport identity
- changes in hunger hormones (Cabre et al., 2022).
It tends to be more common in sports and activities where low body weight and leanness are encouraged, aesthetic based sports (such as figure skating, gymnastics, dance) and in sports that require athletes to fit into a weight category (such as wrestling, rowing and ski jumping). There is also a higher risk of developing REDs in sports where athletes burn large amounts of calories during training (such as marathon, ultramarathon, triathlon, rowing, and cycling) and when there are recent increases in the intensity or duration of training.
Disordered eating and dieting can increase the risk of REDs. However it can also be related to a lack of knowledge around nutrition needs for your sport or due to changes in training or heading into competition without also increasing how much you eat daily.
What are potential signs that you may not be eating enough for your sport?
- Irregular (or lack of) menstrual cycle (females)
- Lowered libido (males)
- Persistent fatigue
- Low mood
- Recurring injuries
- History of a stress fracture within the last 2 years
- Poor performance or not seeing progression in training
- Excessive soreness/poor recovery between sessions
- More frequent illness and/or injury (Canadian Sport Institute Ontario, 2024)
The above symptoms may be warning signs that you are not eating enough for your current training level, putting you at risk for REDs. Other medical reasons for these symptoms need to be ruled out prior to diagnosing inadequate energy availability and/or REDs. A doctor will diagnose REDs and develop a treatment plan that integrates a collaborative multidisciplinary team, including a sport dietitian. If you are struggling with these symptoms, reach out to a dietitian as well as your doctor for support and guidance.
How can we prevent and support treatment of REDs using sport nutrition?
Overall we want to ensure the amount of calories we eat each day, support the energy required to participate in athletics, and for health, function and activities of daily living. We can do this by:
1. Eating every 3-4 hours
At each meal and snack we want to include foods rich in carbohydrates, protein, fat and produce.
2. Prioritizing fueling before and after training
Before training we want to prioritize foods rich in carbohydrates. Such as a bowl of cereal with cow or non-dairy milk or and a banana. After training, we want to prioritize meals and snacks that are higher in carbohydrates, protein and hydration to support recovery. This might look like a smoothie with protein powder or a bowl of pasta with meat or lentil sauce and water on the side.
3. Include carbohydrates during training longer than an hour
For long distance sports such as half marathon and marathon training, long distance cycling, hiking, soccer, hockey, etc, we need to fuel with nutrition during training and competition to maintain energy levels and support needs. This might look like using gels, gummies, sport drinks, fruit, or granola bars.
4. Eat to match your training volume
The more activities and training we participate in, the more calories, protein, and carbohydrates we need to optimize performance and support health! This might look like eating larger meals, reducing vegetable portions to allow for more protein and carbohydrate rich foods at meals, and/or incorporating additional snacks throughout the day. For some who are finding it challenging to eat enough, it might be advised that they reduce how much training they participate in to help recover from REDs.
5. Work towards body neutrality
If we are wrapped up in thinking we need to look a certain way to succeed (or be valued), it will be hard to fuel your body adequately and often enough.
6. Working with a sport dietitian
Having the support of a sport dietitian can help you learn about your individual nutrition needs and find creative ways to ensure your body is well nourished for your health and sport. You can prevent relative energy deficiency in sport, and crush those PRs!
Sara Friedrich is a registered dietitian with expertise in sport nutrition, REDs and food and body relationship support. She is taking new clients virtually (and soon in person in Kelowna) and would love to support you with your sport related goals. Book a free discovery call to connect with Sara and how she can help!
References:
Mountjoy, M., et al. (2023). 2023 International Olympic Committee’s (IOC) consensus statement on Relative Energy Deficiency in Sport (REDs). British Journal of Sport Medicine. 57,1073-1098. DOI: 10.1136/bjsports-2023-106994
Cabre, HE., Moore, SR., Smith-Ryan, AE., & Hackney, AC. (2022). Relative Energy Deficiency in Sport (RED-S): Scientific, Clinical and Practical Implication for the Female Athlete. Dtsch Z Sportmed. 73(7), 225-234. doi:10.5960/dzsm.2022.546
Canadian Sport Institute Ontario (2024). Energy Availability: Self-Assessment. file:///Users/sarafriedrich/Downloads/ea-infographic2_52494114.pdf
