REDS – Relative Energy Deficiency in Sport

There is more and more research coming out regarding training and Relative Energy Deficiency in Sport, or REDS, as I will refer to it from here.

Two things before we go on: I don’t have sufficient medical background to give one on one advice regarding the condition, and, I am not a dietitian. My purpose in writing this is simply to alert you as an athlete or the parent of an athlete to the potential dangers of REDS, so that if worried you can chat to your doctor and/or dietitian.

What is REDS?

In simple terms, athletes ask a lot of their bodies. We place our muscles and skeletal systems under strain, which for the most part is a good thing, in that our bodies adapt to that strain and become stronger over time. However, as we place our bodies under strain our caloric needs, (or put more simply, our need for food), increase. Place your body under strain over a period of time while skimping on correct amounts and types of food can lead to disaster. Things like stress fractures, low sex drive and impaired immunity systems are indicators. It has been calculated that if you supply your body with 300 to 400 less calories per day, you will over a period of 365 days lose out on the equivalent of one months’ worth of eating. For a woman, hormones such as estrogen and progesterone will become unbalanced or low, causing menstrual issues, and for a male, testosterone levels will begin to drop.

You’ve heard it said before in the cycling world that lean and light is the way to go. The golden number to judge whether you’re getting stronger on the bike is to divide your weight by the amount of power that you can generate on a bike for a sustained period of time. It’s not long before you work out that it’s easier to lose weight than it is to generate more power. (Just think of Froome’s arms). So, what we do is to try to get lighter and lighter, often by restricting calories, and then run into the danger of REDS. In other words, your body does not have enough food in it in order to keep itself healthy.

Sports that put athletes at risk include sports that rely on high power to weight ratios. These include running, cycling (2 of the 3 triathlon disciplines) dancing and gymnastics. Sports that require a perceived aesthetic look might also put athletes at risk, swimming and diving would be included in this list. They often draw people with perfectionistic tendencies to them and either draw people who already suffer from disordered or restricted eating, or, can bring those dysfunctional eating patterns out in them.

A Cruel Catch 22 Scenario.

The Catch 22 scenario works as follows; you stop feeding your body with enough food, the body panics and goes into a survival mode. It takes the food that you ingest and tries to store it as fat. In Game of Thrones terminology, it tries to protect you from the coming winter while there is still a bit of food. The food that you give it gets stored as fat and so as you look at yourself in the mirror you observe increasing fat deposits around your body and you come to the conclusion that you’re eating too much and so begin to cut down even more on the food that your body so vitally needs. Stress fractures, tendon damage, muscle pain and impaired immunity become a real threat.
If this is speaking to you it is a good idea to chat to your GP and critically, to begin to consult with a dietitian. It’s also vital that your coach is aware if you feel that you are getting into a danger zone, training volumes and speed need to be cut back drastically until you get out of REDS.

Having said this, is it alright to reduce weight for a few key events each year?
I would say yes, but only for 2 to 3 events per year. Training with a bit of extra body weight will allow you to get stronger and fitter with the added benefit of a pleasant surprise as you get to your key race of the year.

A word of advice for people with stress fractures and recurring tendon issues etc.
You need to look at the injury holistically. Running shoes, tight muscles, weak muscles, muscle imbalances, training load increases, sleep, diet and underlying medical conditions all need to be considered. This might need a multidisciplinary team to help you tick all the above boxes. I would almost always include hyperbaric oxygen therapy into the mix, but only as an add on, and not a solution.

The primary goal of any coach must not be to create fit athletes. The goal needs to be health first and then fitness and speed. That’s where your longevity as an athlete will be found.

Yours in health,

Mike Roscoe.