Energy Availability

Are you eating enough to fuel your performance?

The hard training undertaken by athletes day in day out ensures they have increased energy needs. Achieving those increased needs is a fundamental requirement of an athletes diet, and failing to do so for extended periods of time can have adverse implications on both health and performance.

There are a number of factors that can make fueling for sport challenging and these are specified in the below infographic.

Energy-Availabilty-Infographics-2.pdf

Watching out for the early signs and symptoms of under-fueling can help identify the issue early, and help avoid the potential adverse impact on both health and performance. If you notice one or more of the symptoms below, speak to your sports dietitian who has expert knowledge in helping you to match your fueling needs to training and competition demands.

Energy-Availabilty-Infographics-High-Resolution1.pdf

Relative Energy Deficiency in Sport (RED-S)

Relative Energy Deficiency in Sport (RED-S), is a syndrome which can adversely affect the health and performance of athletes. It exists when under-fueling is sustained for extended periods of time i.e. there is a negative balance between dietary energy intake and the energy expenditure required to support optimal health, daily living activities, growth, and sport. In the simplest terms the underlying cause of RED-S is low energy availability. That is the amount of dietary energy remaining for the body to function properly after accounting for exercise expenditure.

Causes of low energy availability

Although it is often associated with disordered eating or an eating disorder low energy availability can also be caused inadvertently or by mismanaging weight control efforts. Examples of this can include:

• Changes to training/competition load, including short turnarounds between training sessions and/or competitions (i.e. increasing energy exercise expenditure (EEE) above energy intake (EI).
• Lack of skills, time, and/or money for meal planning and preparation.
• Not understanding individual energy needs for sport.

More serious disordered eating which may lead to, or be caused by, an eating disorder may include dieting or the use of fasting, diet pills, laxatives, diuretics etc.

RED-S is most common in sports where leanness and/or weight are important for performance (long distance running, road cycling); aesthetics/appearance (gymnastics, dancing); or to meet a weight category (wrestling, boxing, combat sports).

As the primary cause of RED-S is energy deficiency some early signs can be:

• weight loss
• Disordered Eating or an Eating Disorder
• lack of normal growth and development
• menstrual dysfunction
• recurrent injuries and illnesses
• decreased performance
• mood or social behavioural changes

Clinical management of RED-S

RED-S exists on a continuum from optimal energy availability and physiological health to low energy availability (with or without an eating disorder) severely impacting on physiological health (e.g. menstrual dysfunction, bone health, etc.). The 2014 IOC Consensus statement: beyond the Female Athlete Triad—Relative Energy Deficiency in Sport (RED-S), opens in a new tab provided a simplified diagram of the various health consequences of RED-S, which range from metabolic, to immunological, cardiovascular, and psychological:

• Figure 1: Health Consequences of Relative Energy Deficiency in Sport (RED-S), opens in a new tab.

Additionally, the potential performance effects can include: increased injury risks and decreased performance and training responses, as well as mood changes, depression, and irritability.

• Figure 2: Potential Performance Effects of Relative Energy Deficiency in Sport (RED-S), opens in a new tab.

36037_Clinical-Management-of-Red-S-030621.pdf

Optimising athlete health and performance

Treatment for RED-S, and in particular for the underlying low Energy Availability (EA), will generally involve increasing Energy Intake (EI) potentially in combination with reducing exercise. As there are not currently any standardised guidelines to determine EA, and measurement of both EI and exercise expenditure are frequently imprecise, it can be difficulty to accurately determine optimal conditions for individual EA.

The IOC consensus statement: beyond the Female Athlete Triad—Relative Energy Deficiency in Sport (RED-S), opens in a new tab recommends a practical approach of increasing current EI by ∼300–600kcal/day and addressing suboptimal practices related to energy spread over the day and around exercise sessions, dietary composition, and food-related stress.

Additional treatment may be required to address menstrual dysfunction for women, optimise bone health, and for any psychological conditions which may exist or develop.

It is recommended that treatment and monitoring plans involve a qualified sports medicine practitioner with support from a multi-disciplinary team as required.