Relative Energy Deficiency in Sport (RED-S)
Relative Energy Deficiency in Sport (RED-S), a syndrome identified and supported by the International Olympic Committee1, characterizes a range of negative health and performance outcomes that result from prolonged (>weeks to months) low energy availability (EA2). Low EA (LEA) is defined as insufficient dietary energy intake in relation to energy cost of exercise, ultimately failing to cover the energy cost to optimally support other important body functions (e.g. growth, recovery, bone health etc.). An athlete may develop LEA and subsequently, RED-S intentionally (eating disorders, disordered eating behaviour, or failed attempts to manage body weight and composition) or by accident (inability or lack of knowledge to consume a sufficient amount of calories to match high training loads3). Prolonged LEA is known to impair endocrine function (low female and male sex hormones), bone health (including upwards of a 4.5x increased risk of stress fractures in elite runners4) as well as have negative effects on the cardiovascular system, illness and injury, and performance outcomes1.
Due to its ability to widely affect athlete health and performance, RED-S is currently a challenge amongst all female and male athletes, over all ages and across all sports. In 2019, Own the Podium (OTP) recognized RED-S, along with concussion and musculoskeletal injuries, as one of the 3 key initiatives around Return to Health & Performance and as a result, put together the National RED-S Committee as part of the new High Performance Advisory Council (Performance Sciences). As further outlined below, the Committee aims to create a national strategy to help prevent, identify/diagnose, and treat RED-S in Canadian athletes. The focus will be specifically in creating a detection toolkit and/or protocols for treatment. Furthermore, the aim will be to educate Canadian athletes, coaches and parents on RED-S and ultimately reduce incidence. Finally, the committee will target specific research to better understand incidence of RED-S in Canada and evaluate intervention strategies to support athlete health and performance.
About the work the program/committee is doing
The Committee is currently working on:
- Creating a RED-S website to educate and increase awareness of RED-S among athletes and their support team
- Creating an education module aimed at athletes as well as health care practitioners with the aim of preventing RED-S and enhancing early treatment of potential RED-S cases
- Research around the prevalence and symptoms as well as treatment of RED-S in Canadian development and elite athletes across summer and winter Olympic sports with the goal of more efficient early detection via development of novel screening tools as well as evaluate potential treatment strategies for optimal Return To Performance in athletes with RED-S
- Eventually, based on the work above, the goal will be to create a RED-S Sports Best Practices strategy document that can be appropriately adapted to each sport as required
Frequently Asked Questions
1.Mountjoy M, Sundgot-Borgen JK, Burke LM, et al. IOC consensus statement on relative energy deficiency in sport (RED-S): 2018 update. Br J Sports Med. 2018;52(11):687-97.
2.Loucks AB, Kiens B, Wright HH. Energy availability in athletes. J Sports Sci. 2011;29 Suppl 1:S7-15.
3.Stellingwerff T, Heikura IA, Meeusen R, et al. Overtraining Syndrome (OTS) and Relative Energy Deficiency in Sport (RED‑S): Shared Pathways, Symptoms and Complexities. Sports Med. 2021. https://doi.org/10.1007/s40279-021-01491-0
4.Heikura IA, Uusitalo ALT, Stellingwerff T, et al. Low Energy Availability Is Difficult to Assess but Outcomes Have Large Impact on Bone Injury Rates in Elite Distance Athletes. Int J Sport Nutr Exerc Metab. 2018;28(4):403-11.