RED-S happens when the athlete eats too few calories, compared to what is being burned in practice and play, creating a state of malnourishment. RED-S is short for relative energy deficiency in sports. It used to be called female athletic triad, as it is most commonly observed in female athletes. Although it remains prevalent in women, it is seen occasionally in male athletes, too. That’s one reason for the name change. The other was to more clearly communicate its cause.
Shortage of calories brings a surplus of problems
Because malnutrition disrupts the estrogen balance, the most common first sign is a menstrual cycle disturbance. Missing periods is not normal, no matter how hard you work out.
Depressed estrogen levels also rob the bones of calcium. Left untreated, RED-S causes bone loss. The bones grow porous and weak, making the athlete prone to stress fractures. It can also depress athletic performance and weaken the immune system.
RED-S is not an eating disorder. Although athletes who experience it may also have eating disorders, RED-S is often unintentional, the result of lack of education leading to poor eating habits.
The 1,200 calorie myth
Part of the problem comes from a cliché; the 1,200-calorie diet. The idea that women should eat no more than 1,200 calories a day is embedded in the culture and often repeated in popular media. The fact is that some women need more and some need less, depending on weight, age, genetic makeup, endocrine function, physical activity and other factors.
One reason we see RED-S more often in women may be cultural. Female athletes tend to be more likely than their male counterparts to embrace the 1,200-calorie myth and get themselves in trouble.
Chiropractic and RED-S
Chiropractors are on the lookout for the warning signs, especially when we see an athlete with a history of stress fractures. We ask the right questions to root out other symptoms and eating habits. We can help educate about real-world nutritional needs.
Treating RED-S is straightforward – adjusting eating habits to ensure intake of both enough calories and the right kind. Calcium is key, with a recommended daily intake of at least 1,500 mg. Working together with trainers, coaches and dietitians, the goal is to get the athlete eating enough of the right kinds of foods, like yogurt, cheese, beans and green leafy vegetables. Calcium supplements are added for those who need them, along with vitamin D, key to calcium absorption.
Prevention is the best medicine
RED-S is completely preventable and athletes who recognize and acknowledge the warning signs are less likely to develop it.
- Missing periods is never normal, in the absence of pregnancy. This is a serious warning sign that should never be ignored.
- If you are consistently and significantly underweight, you may be malnourished.
- Other signs include anxiety around meals, fear of food or weight gain, irrational behavior, mood swings, fatigue, low heart rate and feeling abnormally cold.
Stay healthy and stay competitive! Talk to your coach or trainer. Understand how many calories you realistically should be consuming. Know the warning signs. And report them if they happen.