Track & Field Athletes & the Risks of Relative Energy Deficiency in Sport (RED-S)
by Melinda Burris

To properly train and increase the muscle mass and strength necessary to compete, athletes must commit to a well-planned and sustained nutrition and exercise program. A proper balance between food (fuel) intake and energy output must be maintained so that the body’s reserves do not become depleted. While this is a well-established scientific fact, researchers have noticed a worrisome trend that is especially prevalent among female competitors in general, and track and field athletes in particular. Research has shown that individuals in these categories are at an increased risk of reducing their food consumption too much for several reasons, which pushes the body to meet the demands of high activity without the proper resources necessary to produce the energy required. As a result, performance suffers, and the muscles are put under too much strain. Left untreated, this condition, known as relative energy deficiency in sport (RED-S) can have serious and long-lasting consequences for overall health. ^1,2

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A scientific study published in a 2019 issue of the International Journal of Sport Nutrition and Exercise Metabolism noted the “reported prevalence of low energy availability (LEA) in female and male track and field athletes is between 18% and 58% with the highest prevalence among athletes in endurance and jump events.”² Research has shown that LEA can cause serious health problems in the short and long-term. For instance, the study observes, “In male athletes, LEA may result in reduced testosterone levels and libido along with impaired training capacity. In female track and field athletes, functional hypothalamic amenorrhea as [a] consequence of LEA has been reported among 60% of elite middle- and long-distance athletes and 23% among elite sprinters.”²

Functional hypothalamic amenorrhea is when the hypothalamus triggers regular menstrual periods to cease. Other serious health concerns associated with functional hypothalamic amenorrhea include increased risk for heart disease and severely impaired bone health which can result in unnaturally short stature, skeletal fragility, and a decrease in peak bone mass (PBM).^2,3 Other side effects of LEA can include slower recovery times, depletion in muscle mass, a negative impact on neuromuscular function, and heightened risk of injury or proneness to sickness which may affect the athlete’s performance or even their ability to compete.²

Interestingly, researchers have found evidence to suggest that “LEA in track and field athletes may occur due to intentional alterations in body mass or body composition, appetite changes, time constraints, or disordered eating behavior.”² This may be linked to an athlete’s desire to force their body to conform to the characteristics most sought after in athletes in their particular field and specialty.

Scientists conducting the 2019 study used track and field athletes as an example, noting, “Middle- and long-distance athletes tend to be small and lean; high jumpers are usually tall and lean; and power athletes (sprints, long and triple jump, pole vault, heptathlon, and decathlon) are both lean and more muscular and powerful. In contrast, throwers tend to be larger with higher adiposity.”² The researchers surmise that the intentional decrease in food consumption while maintaining a high energy expenditure rate, the root cause of RED-S, “…may occur…to optimize body mass or body composition for competition, to avoid weight gain during injury and illness or due to eating disorders (EDs) or DE (disordered eating behavior).”² Another common cause of decreased food consumption mentioned by several experts is that the athlete may lose their appetite if they are overly fatigued from too much high-intensity training.

Coaches and trainers of student-athletes need to be aware that although LEA is most frequently associated with and diagnosed in adult track and field athletes, the 2019 study finds “there is compelling evidence that LEA with and without DE may start during youth.”²  The study then cites another research study into energy availability (EA) among female high school athletes demonstrating a “similar prevalence of subclinical LEA among athletes (31%) and controls (39%).”  It is also noteworthy that research shows high school runners are particularly prone to develop specific attitudes as to what constitutes the “ideal body type”.² Not surprisingly, a high incidence of DE among high school runners has been reported with more than “23% of girls and 8% of boys [reporting] dieting or skipping meals to lose weight.” A subset of participants in this study self-identified as believing “that thinner leads to faster running performances”.² More than 50% of the girls in this subset and two-thirds of the boys believed this to be true.²  These findings underscore the fact that we live in a society that sets a high value on what a particular type of person or athlete should look like and we are beset with messages such as “Just Do It” which can reinforce the notion in some that they can force their bodies beyond their limitations.

Conclusion

Coaches and trainers of track and field athletes should educate themselves on the early signs and symptoms of RED-S and be vigilant in observing athletes’ performance, particularly when an athlete repeatedly shows signs of fatigue and loss of power. Encourage and initiate open communication with athletes and provide preventative educational programs so athletes are aware of the long-term health consequences LEA and ED can have on the body, both physically and mentally. It is also good practice to encourage or even require athletes to keep a journal of their daily food intake to increase their awareness of how much food they are consuming so they can track whether it is sufficient for the physical demands they are placing on their bodies.

It is important that RED-S and its underlying cause, LEA, be taken seriously. Successful treatment for athletes who develop full-blown RED-S frequently requires a team of multi-disciplinary professionals: a sports physician, a dietician specializing in sports dietetics and nutritional counseling for athletes, as well as a physiologist and psychiatrist working together to provide a holistic treatment solution.

References:

1. The Conversation. (14 August 2023). Running on Empty: Female Athletes’ Health and Performance at Risk from Not Eating Enough.
2. Klein, A.E., et al. (2019). Energy Availability in Athletics: Health, Performance, and Physique.
3. Indirli R., et al. (11 October 2022). Bone Health in Functional Hypothalamic Amenorrhea: What the Endocrinologist Needs to Know.

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