By Isabelle Banin

It’s intuitive that people who burn a lot of calories need to eat a lot of food. But how much does fueling actually matter?

Athletes who under fuel are at risk for developing the syndrome Relative Energy Deficiency in Sport (RED-S). The health consequences of this syndrome are extensive and can impact physically active people of all ages and genders. If you have never heard of RED-S before, you’re not the only one. RED-S, which was previously called Female Athlete Triad, is under recognized.

NorthShore Sports Medicine Physician Kirsten E. Geary, M.D., explains what RED-S is, what to look for and how to get your body back on track.

“RED-S occurs when athletes are not providing their bodies with enough nutrition to support the increased fuel needs that they have,” Dr. Geary said. “This syndrome can result from overtraining, under consuming calories or a mix of the two.”

RED-S is not an eating disorder and may result from unintentional undereating, though disordered eating, such as skipping meals, and eating disorders are a risk factor. If you compete in an endurance sport (running), aesthetic sport (figure skating), or weight class sport (i.e., wrestling), you are also at a higher risk of developing this syndrome. No matter your risk level, knowing the signs of RED-S is important.

“Keep an eye out for repetitive injuries, stress fractures, missed or delayed periods, decreased exercise tolerance, decreased performance and longer recovery times,” Dr. Geary advised. “Knowing roughly how much caloric expenditure you’re using up during training can help you make sure you’re consuming enough.”

Athletes with RED-S are prone to injury as a result of lower bone density and other associated symptoms. These symptoms include loss of strength, fatigue, decreased concentration, cardiac abnormalities, gastrointestinal problems, and decreased immunity.

All athletes should be mindful of their condition and food intake, even if they feel healthy and are excelling in their sport. While RED-S harms athletic performance, affected athletes may experience a temporary increase in athletic performance.

Unfortunately, athletes may feel pressured to lose weight and/or overtrain. This pressure stems in part from the false perception that losing weight and/or extra training always increases performance, along with societal beauty standards.

Clearly this issue runs deep, so how do we protect ourselves, our teammates, and our loved ones?

Dr. Geary has some tips to get us started:

• Eat multiple servings a day of calcium rich foods, such as milk and yogurt, to keep your bones healthy. For those who are lactose intolerant, visit Healthy You’s guide for non-dairy calcium sources. Your diet should also be balanced with protein, veggies and complex carbs.
• Seek professional help for yourself and encourage others to do the same. Dietitians will build individualized fueling plans, sports medicine specialists will create rehabilitation programs, and mental health specialists will address the underlying causes and psychological symptoms.
• Educate others about RED-S and encourage the people around you to focus on health and skillset, rather than on physical appearance, body weight and/or body type.

To learn more about your risk for RED-S and receive treatment if you believe you are affected, schedule an appointment with a NorthShore Sports Medicine specialist.