Athlete Diet Concern: Relative Energy Deficiency in Sport (RED-S)

Sports nutrition advice: Are you eating enough calories?

Have you heard of Relative Energy Deficiency in Sport (RED-S)? Chances are you likely have not. Our culture leads us to believe that many of us are eating too much and should work towards eating less and exercising more to fit our bodies into a cookie cutter shape. The reality is, what the popular media is sharing is leading to issues of not consuming enough calories, over-exercising and possible disordered eating patterns for some athletes.

What is Relative Energy Deficiency in Sport (RED-S)?

In high performance sports environments, athletes can have a lack of understanding of how much energy their body needs or are not fueling appropriately around training times. Whatever the reason is, low energy availability or a mismatch between an athlete’s energy intake (diet) and the energy expended during exercise, is leaving individuals with not enough energy required to support optimal health and performance. This low energy availability in combination with other physiological outcomes is also known as Relative Energy Deficiency in Sport or RED-S. These issues are becoming increasingly common, yet there is still a lack of understanding or awareness around it, especially for males.

How does RED-S impact the health and performance of an athlete?

Here is a diagram and some additional information about what happens to health and performance when RED-S is present or there is low energy availability.

Physiologically there are many signs that this low energy availability may be an issue. The responses that occur in the body include (but are not limited to):

• a loss of menstrual function, no period or lack of period at 15 years of age or older
• changes in hormones, hormone function such as alterations in thyroid function or sex-hormones
• stress fractures and reduced bone strength
• slowing of the metabolism or resting metabolic rate
• recurring or frequent viral infections
• digestive upset such as constipation and bloating

There are many other signs of RED-s, but this shows you how the body is affected both in the short term and potentially over the long term for some of these items. I want to emphasize Relative Energy Deficiency in Sport is not always an eating disorder or disordered eating since many athletes or individuals affected by RED-S have a very normal or healthy eating pattern yet are still not eating enough for their training.

Increasing your awareness about RED-S

The first step to alleviating the issue, is the awareness of what is going on. We often do not understand our bodies energy needs as many athletes are not intentionally under fueling for the activity they are doing.

As a previous competitive athlete when I was younger I have personally experienced RED-S. There were moments during stressful times I know I intentionally did not eat as much as I knew I needed but much of the time I simply did not understand how much energy my body needed. I often missed out on a good recovery meal because I just did not know the importance of this meal. Or sometimes I just had carbohydrate rich snacks not realizing I also needed to pair these carbohydrates with sufficient protein. I also didn’t understand that my lack of training response or frequent viral infections was because of not eating enough. Everyone has a different experience, my experience is just one example. As a Sports Dietitian I see RED’S frequently for a variety of reasons.

How to ensure you eat enough calories for sport

Now that we are aware of RED-S, some simple next steps are:

Always have a pre-workout meal and/or snack.

If you are working out in the morning, have a quick, easy to digest snack before. Make this high in carbs with a little bit of protein. If you are training after school or work, do not forget to have an afternoon snack that will provide you the energy you need for that training after a day’s work. The amount and the timing will change but start with ensuring you always have something in your body before your workout; your body needs the energy!

Need some ideas? Check out this previous article on our blog What to Eat Before a Workout

Recovery!! Never skip a recovery snack!

I cannot emphasize this enough. Recovery will provide your body with the energy and nutrients it needs to re-energize and repair the damage you caused by training and build up that muscle we work so hard on. Recovery includes a ratio of 3 carbohydrates to 1 protein or 0.2-0.4g/kg of your body weight of protein and 1-1.2g/kg of your body weight of carbohydrates within 15-30 minutes.

Check out this previous article on our blog What to Eat After a Workout for practical ideas.

Have a snack or a meal every 3-4 hours throughout the day.

This snack should include a source of protein to ensure recovery and a carbohydrate for the energy. Spreading protein intake throughout the day is important. We want it to be available throughout the day for recovery, but we also want to make sure we are including enough carbs and fats at each meal and not overconsuming protein in one sitting.

A sample of meal and protein timing looks like this:

• Breakfast: Grain/Starch, Fruit, 25 g Protein,
• AM Snack: Carbohydrates +10 g Protein
• Lunch: Grain/Starch, Fruit/Vegetable, 25 g Protein
• Post Workout < 1 hour: Carbohydrate + 25 g Protein
• Supper: Grain/Starch, Vegetables, 25 g Protein
• Before Bed: Carbohydrates + 10 g Protein

This sounds simple, but these 3 things will make a HUGE difference. The issue of RED-S is complex and the steps to prevent it and recover from it can be difficult on your own. It is important to seek support from a Sports Dietitian who can make a plan that meets your individual needs, training plan and health. Having that Sports Dietitian work with you and your team (trainer, coach, etc) will help get you on the track to better performance and better health.

DO NOT let diet culture fool you into thinking that we are all eating too much…. The issue of not eating enough is much more common in my office!

Looking for more sports nutrition advice?

Check out these previous articles on our blog:

Why your calorie counting apps and devices may be wrong
3 Tips for improving body confidence
Runners diarrhea and other digestive issues during exercise

Contact us for sports nutrition help!

For more information about our Calgary nutrition counselling services and virtual nutrition coaching with our experienced Registered Dietitian team visit: NUTRITION COUNSELING or Contact Us.