Relative Energy Deficiency

Relative Energy Deficiency -  The risk of under nourishing for your athletic pursuits 

It has long been understood that athletes who train at high levels may have reduced function in other physiological areas, such as bone production and hormone imbalances. We have known this for years in female athletes where they can have ‘the female athlete triad’ - amenorrhea (loss in menstruation, low energy, and osteoporosis (bone density loss). This is commonly associated with not replenishing the calories that the body uses up training and competing in the sport. More recently, it has become evident that athletes of all genders can be subject to the risks associated with insufficient caloric consumption. Those in sports where ‘weight classes’ exist, where being lighter has an advantage, who have to train long hours at high intensity, or where aesthetics are part of the judging criteria can have what is called Relative Energy Deficiency, or REDs. 

Relative energy deficiency is essentially a condition where an athlete is not consuming enough calories to fuel their body both for sport performance and normal physiological functions. This can be because of intentional restriction (e.g. in the case of disordered eating), unintentional restriction (food insecurity, dietary restrictions or sensitivities that make consuming adequate fuel challenging, e.g. being vegan or having celiac disease) or due to high physical output and inability to recoup the energy burned during long duration intense exercise (e.g.simply not being able to eat enough calories to make up the deficit, or during periods of growth where the body requires additional calories). 

What are the risks of RED? While the previous female athlete triad focused on the loss of reproductive health and bone density in women, it is now understood that RED has a more global impact on your whole physiology regardless of gender.

RED can lead to: 

• Impaired growth and development

• Reduced skeletal muscle function

• Impaired cardiovascular function

• Reduced immunity

• Impaired reproductive function

• Impaired bone health

• Impaired gastrointestinal function

• Impaired energy metabolism/regulation

• Impaired hematological function

• Urinary incontinence

• Mental health issues

• Impaired neurocognition

• Sleep disturbances

RED Recovery: On the surface, recovering from RED is simple: Eat more calories. However, it is important to recognize that there may be underlying factors at play. For those who are living with disordered eating patterns, both mental health and dietitian professional support may be needed in order to adjust behaviours around eating. For individuals who have a weight requirement in their sport, care must be given to support their recovery while still meeting their goal when they weigh in. Similarly, aesthetic expectations may impact the athletes ability to increase their caloric consumption while still maintaining the expected standard. Due to the potential long term ramifications of RED, it is important to manage and correct the caloric deficit while still supporting the athlete in the non-performance aspects of their sport. 

What to watch out for athletes in your life?

• Poor performance despite consistent training

• Changes in mental health

• Changes in body mass (weight loss)

• Amenorrhia

• Increased focus on calorie counting or macros

• Loss of libido

• Trouble staying warm

• Hair loss

• Poor focus

None of these signs are cause for an immediate assumption of RED, but in combination they may indicate that someone is at risk, and support from appropriate health care professionals (family doctor, clinical counselor, registered dietitian) may be indicated.