You can throw as many supplements and protein powders in your body to improve your performance, but unless you’re meeting your energy needs, they won’t do anything for you. As an athlete, your most important job is to make sure you’re eating enough on a daily basis. As simple as it sounds, this can be difficult for many athletes to achieve. As a sports RD, I am often discussing strategies with clients to make sure they stay out of the zone of low energy availability (LEA) so they can avoid the condition known as Relative Energy Deficiency in Sport or RED-S.

What is Energy Availability?

Energy availability is broadly defined as the amount of dietary energy remaining after exercise, available for other physiological functions such as growth, muscle recovery, and homeostasis (i.e., regulating body temperature). LEA is when your body does not have enough fuel to support daily processes AND the activities you enjoy. It occurs when the calorie intake of an athlete is insufficient. As a sports RD, I never get tired of saying “eat enough, always!” If concerned about low energy availability, increasing your caloric intake is one way to allow your body to feel and perform at its best.

What is RED-S?

RED-S is currently a hot topic in sports and performance nutrition, and for a very good reason. LEA is associated with the majority of consequences of RED-S. Consequences include, but are not limited to: suppressed metabolic rate, menstrual dysfunction (females) or reduced testosterone levels (males), impairments of bone health, immunity, protein synthesis, and cardiovascular health, and even mental health issues like depression and anxiety.

Can Both Males and Females Experience LEA and RED-S?

Absolutely. While studies on the prevalence of RED-S are somewhat limited, studies show that RED-S affects 22-58% of female and male athletes. This statistic shows it’s very common among athletes of any level and gender. LEA was first proposed in relation to the female athlete triad, which consists of three distinct but interconnected components including energy availability, menstrual function, and bone mineral density. However, because relative energy deficiency affects many aspects of physiological functions other than menstrual function and bone health, and the phenomenon also occurs in men, the International Olympic Committee (IOC) coined the term RED-S. While male athletes do not have the ability to monitor a physical symptom such as menstrual dysfunction like female athletes do, they can still experience the other performance and health consequences associated with LEA and RED-S.

Signs and Symptoms of LEA and RED-S

Here are a few signs and symptoms to look out for if you or someone else is suspected of struggling with LEA or RED-S:

• Reduced training capacity

• Repeated injury or illness

• Delayed or prolonged recovery times

• Change in mood state

• Failure to lose weight or alter desired body composition

• Reduced or low bone density

• Reduced libido

• Cessation or disruption in menstrual cycle (females)

• Excessive fatigue

Performance Consequences

• Decreased endurance performance

• Increased injury risk

• Decreased training response

• Impaired judgment

• Decreased coordination

• Decreased concentration

• Irritability

• Depression

• Decreased glycogen stores

• Decreased muscle strength

 Risk Factors for Developing LEA and RED-S

• Participation in aesthetic, weight making or endurance sports

• Failure to increase calorie intake with increased or hard training loads

• Attempts to lose weight when training loads are high

• Restricted calorie intake due to physical impairments, gut tolerance, or medical conditions

• Excessive focus by coaches and other support staff on weight and body fat as opposed to performance in sport

• Presence of disordered eating behaviors, either in the athlete or in their training partners

• Inadequate food availability

• Diets very high in fiber and low in energy density (e.g. large salads lacking in carbohydrate, tendency to only eat very specific “healthy” foods, extensive use of diet products)

 Why be concerned?

• Potential negative impact on training response/capacity (acute or long-term)

• Suppressed metabolism, which can cause long-term difficulties with body composition

• Reduced bone density, increasing the risk of stress fractures and other bone injuries

• Increased risk of psychological harm

• Acute and chronic health problems

The Relationship Between Fasting and Low Energy Availability

Fasting is the absence of energy intake for a sustained period of time ranging from several hours to days. Not fueling before a morning training session is one example of training in a fasted state, which can lead to LEA and in some cases, RED-S. I like to remind athletes that properly fueling for life in and out of sport is essential to health and performance. This means going into each workout fueled, fueling during your workouts if they’re longer than 60 minutes, and fueling up within one hour after your workout to replenish your glycogen stores and provide your body with the nutrients it needs to rebuild, recover, and ultimately feel safe.

Some Ways to Help Prevent RED-S and LEA as an Athlete

As previously stated, the best way to prevent RED-S and LEA is to make sure you’re eating enough overall. As a sports RD, I never get tired of saying, eat enough, always! Fueling adequately allows you to participate in the activities you love and keep your body’s essential processes going. Here are some of my tips to avoid LEA and consequences associated with RED-S:

• Increase caloric intake by focusing on energy dense foods

  • swap sliced bread for a bagel on sandwiches

  • add cheese, avocado, or hummus to sandwiches

  • saute, roast or stir fry veggies with oil or butter

  • pair mixed nuts with dried fruit and dark chocolate and dates for snacks

  • add nuts, seeds, cheese, and olives to salads

  • add full fat yogurt or nut butter to smoothies

• Prioritize eating before and after workouts

• Structure a meal pattern that includes at least 3 meals per day and 2-3 snacks so you aren’t going long periods of time without food

If you or someone you know is struggling with signs and symptoms of LEA or RED-S, I love working with athletes to reclaim their health. Check out my nutrition services!

References:

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):687-697. doi:10.1136/bjsports-2018-099193

2. Logue DM, Madigan SM, Melin A, et al. Low Energy Availability in Athletes 2020: An Updated Narrative Review of Prevalence, Risk, Within-Day Energy Balance, Knowledge, and Impact on Sports Performance. Nutrients. 2020;12(3):835. Published 2020 Mar 20. doi:10.3390/nu12030835