Relative Energy Deficiency in Sport (RED-S) – The IOC Consensus
by George Blackwell
For this week’s newsletter, I’d like to give a brief overview of the IOC’s 2014 recommendations on Relative Energy Deficiency, and why this matters for athletes of any level looking to optimise their health and performance.
The term ‘Relative Energy Deficiency in Sport’ (RED-S) was introduced in 2014 following a review of the 2005 Consensus Statement on the ‘Female Athlete Triad’ - a female specific condition establishing the relationship between low energy availability, menstrual health, and bone density. The term ‘RED-S’ was introduced to give weight to the broader complexity of these mechanisms, as well as to recognise the fact that male athletes are also affected. The syndrome of ‘RED-S’ refers to impaired physiological function, including (but not limited to) metabolic rate, menstrual function, bone health, immunity, protein synthesis, and cardiovascular health caused by energy deficiency.
In layman’s terms, this means spending an extended period of time where your total energy output in daily living exceeds your dietary intake, impairing your body’s ability to keep up with its general physiological requirements. This can have many short- and long-term implications on health and performance, ranging from under recovery from training to long-term issues such as maintaining hormonal health, developing nutrient deficiencies (such as anaemia) and chronic fatigue.
The intricacies of managing this in athlete populations often stem from the short-term improvement that can be seen from reductions in body weight. However, these eventually compromise health and make the weight loss unsustainable. Athletes that ensure their dietary intake matches the level of their energy expenditure are ultimately healthier from a metabolic / immunological / psychological standpoint, which in the long run results in better (and more sustainable) performance levels. In the long term, they’re able to recover better, be more consistent in their training, and typically get fewer injuries and illnesses.
From experience as an athlete and as a coach, I feel the basic components of energy availability are important for all athletes to understand. If tracked transparently, these elements can help to explain a lack of recovery, lower motivation to train and higher perceived exertion of sessions.
So, what can you do to stay on the right side of the balance between energy intake and expenditure? Some of the key recommendations / strategies from the IOC to reduce the prevalence of RED-S in athlete populations are:
Reduction of emphasis on weight, focusing instead on nutrition and health to enhance performance.
Development of realistic and health-promoting goals related to weight and body composition.
Avoidance of critical comments about an athlete's body shape/weight.
Promotion of awareness that good performance does not always mean the athlete is healthy.
References:
Mountjoy M, Sundgot-Borgen J, Burke L, Carter S, Constantini N, Lebrun C, Meyer N, Sherman R, Steffen K, Budgett R, Ljungqvist A. The IOC consensus statement: beyond the female athlete triad—relative energy deficiency in sport (RED-S). British journal of sports medicine. 2014 Apr 1;48(7):491-7.