If you “eat like a bird” compared to your peers, you might have RED-S (Relative Energy Deficiency in Sport). It is a syndrome of poor health and declining athletic performance seen in athletes who purposely or unknowingly under-fuel for the energy requirements of their sport and daily lives. RED-S can and does affect athletes of any gender and ability level, however much of the research has surrounded those who were assigned female at birth due to the commonly seen symptom of amenorrhea (the absence of a menstrual cycle).
Nevertheless, there are a lot of symptoms that are aligned in both men and women such as:
• slowed heart rate and slow digestion that leads to nausea, bloating, early fullness, and constipation
• cold hands and feet
• irritability, insomnia
• bone stress fractures, brittle hair, and dry skin.
Tell-tale signs of RED-S in sexual health are seen in women as irregular or absent menstrual periods and lack of cervical fluid. Men will notice fewer morning erections, decreased sex drive, and low fertility (when tested). Overall, athletes with RED-S will feel their performance weakening and their workouts/training won’t feel the way they used to.
Tina Muir, a former elite runner and RED-S case study, is passionate about educating others about RED-S in males and females. Her channel Running for Real and podcasts offer extremely helpful information surrounding the different areas of RED-S. She explains how to figure out if you have RED-S, what to do if you have it, and other helpful information surrounding the condition. She has interviewed top health professionals who offer actionable steps to improve health via YouTube. Here is the link to the Running for Real YouTube channel which has much more information on the specifics for someone who thinks they have RED-S or information that someone with RED-S should know. The following questions are examples of the topics she addresses—along with the answers:
What are the common etiologies of RED-S in men versus women?
In men, RED-S tends to occur by increasing the volume of training, while women tend to experience it as a result of cutting calories. In addition, older men, and women who are postmenopausal, will experience more bone stress injuries, higher risk for osteoporosis, and gut health implications due to RED-S.
I don’t run that much, why don’t I get my period?
Everyone is different and each body has different needs. Your body doesn’t care what or why you are doing something when it experiences RED-S; it is simply telling you it needs to be better fueled to do what you want to be doing. If your body is experiencing symptoms that result from underfueling, you have to believe it because everyone’s needs are unique. Comparing yourself to someone else’s fueling and training regime does not give you more insight into your own body’s needs.
Why should I care if my period is missing? I don’t even want kids!
A regular menstrual cycle is an indicator of health. When you are experiencing an abnormal or absent cycle that reveals a change in your normal hormone levels. This discrepancy can have devastating effects on other body processes. For example, your bones suffer when you are not having regular menstrual periods. This can interfere with your athletic potential as there will be an increased likelihood of bone fractures. Irregular hormone levels will affect your longevity as an athlete. The best step towards recovery is to get a nutrition checkup with a Registered Dietitian (RD) to see if you are adequately fueling for your sport. Recovering from RED-S comes with so many benefits, while missing a period may be welcomed, it is a sign your body is not doing well. So, even if you are uninterested in having kids, or are done having kids, there are so many other pieces of the puzzle that are being affected by underfueling and can be resolved with RED-S recovery.
Do I have to stop exercising while recovering from RED-S?
While it can be difficult to do when it is such a large part of your life, it is recommended to stop exercising while recovering from RED-S. However, by saying no to exercise now, you give yourself the opportunity to say yes to your health and successful exercise in the future. By saying no to exercise now, it allows you to say yes to spending time with friends and family as well as engaging in new or old hobbies you forgot about. This mind shift can help you through your recovery process and encourage you to say yes to things you may have pushed aside due to low energy from RED-S and your training.
I just found out I have RED-S in my senior year and I need a scholarship! What should I do?
While it is extremely important to take time off when you have RED-S, there is a lot of pressure in your senior year of high school, especially when you need a scholarship to be able to afford college. This can be hard to wrestle with but here is what you should consider:
1. What are the consequences of continuing exercise with RED-S?
This can result in a pelvic stress fracture, sacral stress fracture, broken bones, reproductive health issues, and even long-term effects into your 40’s.
2. What else can I do?
Having an open dialogue with a coach or athletic program and being transparent about having RED-S can save you from a lot of damage. There are a lot of protections in place for people with injuries, which RED-S is considered an injury! Those who are willing to give you scholarships are able to see your progress in previous years and can see your potential. If you display your dedication to the program but also explain you need to take action for your health, you may be able to align the two to maximize what you can do for the team without jeopardizing your health.
Why is it important to adequately fuel your sport?
An important takeaway from Tina Muir’s RED-S resource is that the act of self-care and kindness that comes with recovery from RED-S translates into better performance. With better fueling, you protect yourself from injury and improve your energy. We know a bone stress injury can take at least 8 to 16 weeks to heal. Fueling adequately is so important in preventing injury and can greatly increase your performance so you can continue to do what you love!
Please use Tina’s RED-S RECOVERY RESOURCE information and share it with anyone who may benefit from the content. This can be a great resource for coaches to share with athletes to raise awareness on how important fueling for your sport is!
Written by guest blogger and Simmons University nutrition student Angela Smith.