The "Female Athlete Triad" emerged in the 1990s when researchers began to better understand the etiological adaptation of female athletes' health to sports training. The triad addressed three aspects: eating disorders, amenorrhea, and osteoporosis. However, in the last 10 years, the scientific community has recognized that the "triad" approach was too limited, and thus the concept of RED-S (Relative Energy Deficiency Syndrome) emerged, broadening the scope to include men, as well as a wider range of physiological and psychological impacts.
Although RED-S can occur in both men and women, the signs are more evident in women due to menstrual changes.
RED-S is defined as a state of imbalance between energy consumed (through food) and energy expended in daily activities and physical exercise. This prolonged energy deficit compromises important physiological functions such as reproductive health, metabolism, the immune system, bone density, cardiovascular health, and athletic performance.
In summary, RED-S occurs when the body does not have enough energy to sustain all its essential functions, leading to negative consequences for health and physical performance.
Among the main causes that lead to the development of RED-S, we can cite four main ones:
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Voluntary dietary restriction: common in athletes seeking to reduce body weight to improve performance or aesthetics (more common in sports where low weight or aesthetic issues have a strong influence, such as ballet, gymnastics, among others).
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Excessive increase in training load (without proportional adjustment in caloric intake).
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Psychological factors: such as pressure to achieve a certain body standard, which leads to the development of eating disorders (bulimia and anorexia).
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Lack of proper nutritional planning, especially in amateur athletes who do not have guidance from nutritionists or specialized professionals.
Symptoms
Symptoms of RED-S can vary depending on the degree of energy deficiency and the body systems affected. Physical symptoms include changes in the menstrual cycle such as amenorrhea (absence of menstruation); reduced libido (in both men and women); persistent fatigue; decreased athletic performance; increased susceptibility to injuries (especially stress fractures); loss of muscle mass and difficulty gaining strength; and compromised immune system (resulting in increased susceptibility to infections, flu, and colds). Psychological symptoms are also frequently present and significant, such as irritability and mood swings; depression or anxiety; obsessive focus on diet and body weight; and eating disorders (such as anorexia or bulimia nervosa).
Treatment
Treatment for RED-S requires an interdisciplinary approach involving physicians, nutritionists, psychologists, and sports coaches. The main goals of treatment include restoring energy balance and addressing the impacts caused by energy deficiency.
References:
Lodge MT, Ward-Ritacco CL, Melanson KJ. Considerations of Low Carbohydrate Availability (LCA) to Relative Energy Deficiency in Sport (RED-S) in Female Endurance Athletes: A Narrative Review. Nutrients. 2023 Oct 20;15(20):4457. doi: 10.3390/nu15204457. PMID: 37892531; PMCID: PMC10609849.
Cabre HE, Moore SR, Smith-Ryan AE, Hackney AC. Relative Energy Deficiency in Sport (RED-S): Scientific, Clinical, and Practical Implications for the Female Athlete. Dtsch Z Sportmed. 2022;73(7):225-234. doi: 10.5960/dzsm.2022.546. Epub 2022 Nov 1. PMID: 36479178; PMCID: PMC9724109.
