By Elissa Rosen, MD, CEDS
Many of you may be familiar with the term Female Athlete Triad. This term was first coined in the 1990s by a task force of the American College of Sports Medicine (ACSM) in order to describe three interrelated conditions that lead to negative health outcomes in female athletes1. The three prongs of the Female Athlete Triad evolved to include low energy availability, amenorrhea (or loss of a menstrual cycle for more than 90 days), and osteoporosis (or low bone mineral density and increased risk of fracture). Each are interconnected as follows: poor nutritional intake leads to decreased female sex hormone production, loss of normal menstruation, and bone density loss or thin, fragile bones more susceptible to fracture.
The general goal of the Triad was to allow for increased awareness of these conditions so that early intervention could be pursued in athletes that had one or more of its features.
Recognizing that low energy availability, i.e., too little food intake relative to activity level, and the resultant negative health outcomes are NOT unique to females, a new more, comprehensive term was created in the last few years. Relative Energy Deficiency in Sport or RED-S has now replaced the term Female Athlete Triad. The term RED-S not only acknowledges that athletes of all genders can suffer from low energy availability, but also highlights that the health consequences of improper fueling for sport are far greater than just reproductive and bone health2. The 2014 International Olympic Committee (IOC) consensus statement on RED-S clearly outlines how under fueling for sport can negatively impact the physical and psychological health of an athlete. They identify that RED-S can lead to dysfunction of many body systems which can decrease athletic performance and increase risk of serious health complications.
My favorite diagrams from the 2014 IOC consensus statement paper are included below to provide you with a visual perspective of how RED-S can impact both an athlete’s body systems and performance. For more information on RED-S, I invite you to read the full 2014 IOC consensus statement listed as reference number 2 below.
Figure 1. Credit for Image given to Reference 2 (above).
Health Consequences of Relative Energy Deficiency in Sport (RED-S) showing an expanded concept of the Female Athlete Triad to acknowledge a wider range of outcomes and the application to male athletes
Figure 2: Credit Given to Reference 2 (above).
Potential Performance Effects of Relative Energy Deficiency in Sport.
References:
1. De Souza MJ, Nattiv A, Joy E, Misra M, Williams NI, Mallinson RJ, Gibbs JC, Olmsted M, Goolsby M, Matheson G; Expert Panel.. 2014 Female Athlete Triad Coalition Consensus Statement on Treatment and Return to Play of the Female Athlete Triad: 1st International Conference held in San Francisco, California, May 2012 and 2nd International Conference held in Indianapolis, Indiana, May 2013. Br J Sports Med. 2014 Feb;48(4):289. doi: 10.1136/bjsports-2013-093218. PubMed PMID: 24463911.
2. Mountjoy M, Sundgot-Borgen J, Burke L, Carter S, Constantini N, Lebrun C, Meyer N, Sherman R, Steffen K, Budgett R, Ljungqvist A. The IOC consensus statement: beyond the Female Athlete Triad--Relative Energy Deficiency in Sport (RED-S). Br J Sports Med. 2014 Apr;48(7):491-7. doi: 10.1136/bjsports-2014-093502. PubMed PMID: 24620037.