United States: When Pippa Woolven was offered an athletic scholarship to run cross country and track at her dream school, Florida State University, she was thrilled. Moving from England to Florida, she embraced the sport with passion. However, what began as an exciting adventure soon turned into a challenging ordeal, highlighting the dangers of relative energy deficiency in sports (RED-S).
The Passion and the Struggle
Initially, Woolven loved being part of a community of athletes who shared her passion for running. However, her enthusiasm soon gave way to months of illness, consistent injury, and overwhelming fatigue. Woolven initially believed these symptoms were just part of being an athlete. But as they persisted, she realized something was wrong.
What is RED-S?
RED-S occurs when athletes expend more energy than they consume through food. This energy deficit means the body lacks the necessary fuel for essential functions, including fighting infections, rebuilding bone, regulating emotions, and maintaining muscle and menstrual cycles. While RED-S is a relatively new term, it is related to the older concept of the female athlete triad.
The Female Athlete Triad
The female athlete triad includes three interrelated conditions: disordered eating, menstrual cycle irregularity, and low bone mineral density (osteoporosis). This triad was first identified in 1992 by the American College of Sports Medicine, highlighting the impact of intense training and weight concerns on female athletes.
Disordered Eating
Disordered eating involves behaviors like restricting food intake, obsessing over calories, skipping meals, and inducing vomiting, often driven by sport-related pressures. In sports emphasizing a certain body image, such as ballet or gymnastics, athletes may face immense pressure to maintain a specific look, leading to disordered eating.
Dysmenorrhea
Dysmenorrhea, characterized by menstrual cramps and pelvic pain, or amenorrhea, the absence of menstrual periods, can result from disordered eating. When the body lacks proper nutrition, it ceases hormone production necessary for a regular ovulation cycle, prioritizing survival functions instead.
Osteoporosis
Low bone mineral density, commonly associated with aging, can affect young athletes experiencing the female athlete triad. Disordered eating and irregular periods lead to low estrogen levels, crucial for bone health, increasing the risk of stress fractures and osteoporosis.
In 2014, the International Olympic Committee introduced the term RED-S to describe the broader health impacts of low energy availability (LEA) across genders. LEA occurs when an athlete’s energy expenditure exceeds their dietary intake, leaving insufficient energy for vital bodily functions. This energy deficit can cause a range of symptoms, including psychological issues, fatigue, gastrointestinal problems, and more.
Symptoms of RED-S
RED-S affects the entire body, and its symptoms can vary widely. Some of the symptoms include:
Increased Injury Risk: Frequent injuries, especially stress fractures, are common in athletes with RED-S.
Mental Health Issues: Depression, anxiety, and irritability are often seen in athletes with RED-S.
Menstrual Irregularities: Loss or dysregulation of menstrual function is a significant symptom.
Decreased Muscle Strength: Difficulty building or maintaining muscle strength due to hormonal imbalances.
Iron Deficiency: Low nutrient intake can lead to iron deficiency anemia.
Gastrointestinal Problems: Constipation and stool leakage are common gastrointestinal issues.
Reduced Athletic Performance: Overall performance declines, often prompting athletes to seek help.
Causes and Risks
RED-S can affect any athlete, regardless of gender. The transition from the female athlete triad to RED-S underscores that anyone can be impacted by low energy availability. Factors like sport-specific pressures, intense training, and inadequate nutrition contribute to the development of RED-S.
Athletes in sports that emphasize body weight, like running and cycling, or those focusing on aesthetic performance, like ballet, are particularly vulnerable. Even older athletes can experience RED-S, especially when they diet to manage age-related weight gain, inadvertently creating an energy deficit.
Recognizing and Preventing RED-S
Recognizing RED-S can be challenging because symptoms develop slowly and are often ingrained in sports culture. Early warning signs include restrictive eating habits and a decline in physical and mental health. It’s crucial for athletes to talk about their experiences and seek help.
Preventing RED-S involves understanding proper nutrition and viewing food as fuel. Athletes should balance their energy intake with their expenditure to avoid energy deficiency. Working with a registered dietitian can be instrumental in developing healthy nutrition habits.
Pippa Woolven’s journey inspired her to create Project RED-S, an organization providing information and support to athletes struggling with energy deficiency. Her story highlights the importance of awareness, conversation, and proper nutrition in preventing and managing RED-S.
Have you or someone you know experienced symptoms of RED-S? What strategies have helped you manage or prevent this condition? Share your thoughts and experiences in the comments below. Your insights could help others navigate their own health journeys and contribute to a supportive community for athletes facing similar challenges.