RED-S: Relative Energy Deficiency in Sport
Relative energy deficiency in sport (RED-S) is something that is new to me but something I think needs more recognition. In fact, I think it is something that all players, coaches and medical teams need to be aware of.
The first time I came across RED-S was in August 2020 when I stumbled across a tweet by Adrianne Phebey. That tweet led me to find out more, read more and research into other factors that surround RED-S. The more I have read, the more I have realised that it remains poorly recognised by health professionals, coaches and athletes.
Therefore, I hope that this blog, downloadable poster and self-assessment document helps raise awareness among those involved in basketball.
What is RED-S?
RED-S occurs as the result of a mismatch between the amounts you are eating versus the amount of energy that you are using up. Resulting in low energy availability. This under-fuelling can be either deliberate or unintentional, but both can have a huge impact on your health. It has a wide range of adverse effects on all systems of the body, impacting long-term health and performance.
Whilst RED-S is especially common in weight-making and endurance sports, it can affect men and women of all ages in all different types of sports.
Why do some athletes experience low energy availability?
Restricted eating and overtraining are the main risks for athletes developing RED-S. However, there may be a number of reasons as to why this occurs. Whilst an eating disorder may be the most obvious cause, there will often be multiple drivers.
Athletes who are competitive or have perfectionist personality types might also be a risk factor. This could also be driven by an athlete’s coach who is pushing the athlete to work hard all the time. In addition to this, certain athletes may believe they need to :
- Look a particular way
- Eat certain foods
- Train hard all the time (no pain, no gain)
- Complete a certain amount of training sessions per week
The pressure to conform to particular physical attributes or approaches to training can come from a wide spectrum of people and mediums; not just their coach. The pressure can come from friends, family, teammates and medical staff. In addition to this, the pressure could come from the sport more widely and probably most of all from social media.
For female athletes
It is worth noting that a regular menstrual cycle is one of the best signs of health and especially hormone health. Not starting a period by the age of 16 or not having periods for more than 6 months is a sign that you require some medical intervention.
It is worth keeping a track of your menstrual cycle and general health so that you know what your normal is. There is no need to be obsessive with tracking every minute detail but knowing your body will have its advantages. If there is a change, you can seek support early.
Additionally, oral contraceptive pills (OCP) can mask problems without providing adequate bone protection. It is worthwhile understanding what concentration you are on and why. This will help you make the best-informed decision, taking into account the risk factors for RED-S and any requirements you may need for bone protection.
How does RED-S impact your health and performance?
RED-S has a wide range of effects across all systems of the body:
- Mood swings/ irritability/ anxiety/ difficulty managing stress
- Frequent colds & illnesses
- Difficulty building muscle/making weight
- Changes in digestion such as IBS symptoms
- Loss of sex drive
- Poor Sleep
- Irregular or absent periods in women
- Recurrent injuries
- Prolonged recovery
- Reduced concentration and coordination
- Poor performance
Train smarter, not harder
If you are experiencing any of these symptoms, consider whether you are meeting your energy requirements.
Are you overtraining?
Do you eat enough calories?
Are you including sufficient carbohydrates to fuel your training sessions?
Do you take enough rest and recovery days?
Rest and recovery are just as important as training.
Why is it important to highlight and address RED-S?
It is important for all those in basketball to have an awareness of RED-S. As with many health topics, the more players, coaches and medical staff are having open conversations, the more likely someone will discuss their issues. They can then seek appropriate advice.
Highlighting RED-S can help with:
- Injury prevention
- Protect bone health
- Hormone health and fertility
- Digestive health
- Cardiovascular health
- Immune health
- Psychological health
- Performance
What to do if you suspect you might be experiencing symptoms of RED-S?
It is important to talk to someone if you feel that you have symptoms of RED-S. Talk to your coach and get an appointment with your GP. Your GP will be able to run tests to exclude any other medical conditions. Your GP can also refer you to a specialist RED-S service.
If you are interested in knowing more, here are some great sites, resources and articles with more information about RED-S. You can also download the poster and self-assessment tool using the buttons further down the page.
Nicky Keay (Sports Medicine/Endocrinology)
Final Notes
Massive thank you to Adrianne for helping create the poster and her text helped write this blog.
Finally, remember, these resources should not replace diagnosis and management from a medical professional. Always check before you follow the guidance and feel free to drop us a message if you want to discuss anything covered further.
Download the free RED-S poster and self-assessment sheet using the buttons below.
If you liked the free guide and resources, your support can help us to create more resources.
Help us keep all those involved in the game healthy and on the court.
Thank you for your continued support.
