Relative Energy Deficiency in Sport (RED-S) is a serious, often overlooked medical challenge that affects both recreational and elite female athletes. When menstruation ceases, and athletes experience energy deficiency with low body weight, the diagnosis could be the RED-S syndrome.
RED-S Overview
The RED-S diagnosis signifies a persistent energy deficit in sports that impairs physiological functions of multiple organ systems. Formerly known as the Female Athlete Triad, RED-S was introduced by the International Olympic Committee in 2014, affecting athletes irrespective of gender. The prevalence is estimated to be 40-60%, varying depending on the sport.
Symptoms and Long-Term Consequences
Symptoms of RED-S include prolonged recovery times, performance plateaus, fatigue, increased susceptibility to infections, mood swings, gastrointestinal issues, injuries, and stress fractures. Long-term consequences may involve bone density loss, an increased risk of cardiovascular diseases, and osteoporosis.
Gynecological Significance
The absence of menstrual periods often leads women to gynecologists, who play a key role in diagnosis and treatment. The hypothalamus-pituitary axis is inhibited, leading to hormonal changes. The Female Athlete Triad involves low energy availability, amenorrhea, and decreased bone density.
Sport and Hormone Health: Positive Aspects and Risks
Sport and physical activity have positive effects on women's hormone health, particularly in disease prevention. However, intensive training and energy deficiency can lead to RED-S, emphasizing the importance of a balanced approach.
RED-S in Men: A Risk Not to Overlook
Not only women are affected by RED-S; men are also at risk. An energy availability of less than 25 kcal/kg FFM/day is suggested as a trigger for the syndrome. While male athletes have a lower risk of developing eating disorders, the prevalence in elite cyclists is 50%.
Causes and Pathophysiology: An Overview
The cause of RED-S lies in low energy availability caused by insufficient caloric intake. Energy availability, defined as the difference between energy intake and expenditure, plays a crucial role. Disruption of LH pulsatility at an energy availability of <30 kcal/kg FFM/day is a critical threshold.
Health Impacts: Beyond Athletic Impairments
RED-S has extensive health impacts, from gastrointestinal problems to hematological symptoms and an increased cardiovascular risk. Psychologically, affected athletes tend to exhibit perfectionism, low self-esteem, and susceptibility to mental stress.
Treatment and Prevention: A Holistic Approach
The treatment of RED-S requires a holistic approach involving increased energy availability, reduced training volume, and collaboration among different disciplines. Prevention should start in sports clubs, guided by coaches, and parents, to avoid irreversible long-term consequences.
RED-S is a complex challenge that requires a coordinated effort from the entire sports community. Raising awareness among sports clubs, coaches, parents, and doctors is crucial for promoting prevention. The long-term effects of RED-S on athletes' health underscore the importance of early intervention and comprehensive treatment.
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