RED-S stands for Relative Energy Deficiency in Sport. It has been replaced from the previous concept of the ‘female athlete triad’ as this:
1) affects males as well and
2) has far more implications than just menstrual abnormalities, low bone density and disordered eating.
RED-S is now a more encompassing term used to describe a mismatch in energy expenditure to energy intake. If an athlete gets injured often, suffers from stress fractures, has irregular or absent periods, gets respiratory or gastro illnesses often or has poor mental health and they exercise regularly, then RED-S syndrome should be considered as a possible cause (and a reversible one too).
When energy intake is mismatched with output, then vital biological processes start to become impaired one by one and the body focuses on purely just surviving instead of thriving. It dampens down body systems that use up energy such as the brain (which presents as brain fog or fatigue), the immune system (which means you get ill more often), the reproductive system (which presents as irregular or the absence of periods) and your bones (which means you have low bone density and are at increased risk of stress fractures and injury). Initial symptoms may seem trivial such as general fatigue, which can be confused as being due to increasing one’s training load. However, it is often the start of RED-S.
RED-S can lead to a few kilos of weight loss and then initially improved performance in some sports such as endurance sports. However, this is not sustainable and performance quickly plummets as it is intercepted by complications of RED-S such as injuries, stress fractures, illness, anaemia and fatigue.
What is more worrying, is that in sports such as running, bodybuilding, dancing or gymnastics, losing your period is normalised as ‘part of the game’. This culture can be detrimental to the longevity of the athlete in the sport. Additionally, RED-S can spiral into mental health illness very quickly as poor nutrition can lead to the disruption of important neurotransmitters in the brain which are involved in mood regulation. This along with the high-intensity environment of elite sport can compound into athlete burn out.
So what can be done to prevent RED-S? Here are some suggestions:
- Discuss the menstrual cycle more openly. The menstrual cycle should be discussed with athletes as much as other performance factors such as sleep, nutrition and life stressors.
- Make sure you consume an adequate amount of carbohydrates prior to each training session. Carbohydrates will provide you with enough fuel to perform at your best and give it your all during each training session, which will inevitably allow you to grow and progress. If you do not have enough carbohydrates or glycogen in your body prior to training, your body next resorts to muscle as an energy source as it is much easier to break down than fat. This can make you fatigue more easily and can hinder muscular growth and therefore athletic performance and progress.
- Move up a weight class if you are struggling to stay below your current one. Performance increases at higher muscle masses for most sports than at lower muscle masses. It also provides more room for growth and progress.
- Lead by example and put an end to comments, ‘good’ or ‘bad’, about athletes’ bodies. Only a few sports have anything to do with appearance; keep it that way.
- Educate yourself on the correct caloric intake for YOU. This however requires time, and access to financial and educational resources which are privileges that not everyone has. If you are an athlete, I would highly recommend discussing with a dietitian or qualified sports nutritionist on the correct macronutrient intake and makeup specifically for your needs.
Easy ways to fuel up on the go and make sure your get adequate caloric intake is with a few of the Nothing Naughty products. My top recommendations would be the fruit bars or the collagen bars!
Written by Dr Shehnaz Hussain
@shehnazzy @shehnazzy_cooks
Train Hard, Recover Harder.
When you’re putting your body under stress through training, you want it to recover well in order to get stronger and fitter, particularly at higher volumes of training. Getting a good dose of protein around training is especially important for women, because of how the hormones progesterone and oestrogen work in a women's body. A little bit of protein before and definitely after training helps counteract the impact of progesterone in the high hormone phase of a woman’s cycle, and helps our muscles to recover and adapt.
As women’s Sports Physiologist Stacy Sims explains in her groundbreaking book ‘Roar’, progesterone increases muscle breakdown (catabolism) and is elevated during the high hormone phase of the menstrual cycle – the two weeks before a period. During this time oestrogen levels are also high which impacts women’s capacity to access and used stored carbohydrate (muscle glycogen turnover).
Our bodies need available carbs to prevent us from eating into our muscles during exercise, and to help us to recover quickly when we’re done. So during the high hormone phase, it’s especially important for women to get a good dose of protein and carbs to counteract the progesterone aspect, particularly post exercise.
Stacy has outlined a few simple ways to counteract the effects these hormones have on performance and recovery. She recommends:
10 grams of protein before exercise
20-25 grams of protein after exercise, within 30 minutes
Protein before exercise increases the amount of amino acids circulating, so you end up with less of a signal to break down muscle tissue from progesterone. It also kick starts your ability to recover by having these amino acids circulating.
Protein after exercise helps with muscle repair and adaptation. Ideally you want a mix of a fast release protein (for example whey) then a slower release protein (for example casein, found in dairy products). Then you have a longer time of circulating amino acids to help with recovery. Rice or Pea protein has a similar amino profile to whey as a plant-based alternative.
What could this look like in practice?
For me, before exercise, I find a Nothing Naughty plant-based protein bar is a really good option – they are around 12g of protein per bar, sit well in my stomach, are convenient on the go and delicious! I like to have one with a coffee for morning tea in advance of a lunchtime HITT or strength class at my gym.
For immediately after exercise a scoop of protein in a smoothie is around 20-25g protein. Other good options are yogurt with protein powder and fruit, or rice cakes with nut butter and banana. Our muscles are most receptive to storing glycogen immediately after exercise, so including some carbohydrate with the protein is also important for recovery, particularly after intense training.
I like to make what I call a ‘berry protein smush’ – it’s quick to prepare, portable and can be made in bulk and frozen/defrosted beforehand. Easy to make it plant-based. See below for recipe!
Stacy Sims also recommends increasing hydration and salt intake right before and during a period and explores hydration in more detail in her book 'Roar'.
In summary, consuming protein around training helps women maximize adaptation and recovery, which helps you maintain consistency of training, which is ultimately key to success, particularly in endurance-based sports.
Protein Berry Smush
1 scoop protein powder (I use nothing naughty unflavoured rice protein powder)
Some frozen berries – blueberries are great
Some cocoa powder – make it as chocolatey as you want
Shake of cinnamon
Mix up with some milk – I use coconut but any type is fine - into a yoghurt-like consistency
(For a higher-glucose option, add some honey, rice syrup or maple syrup)
Optional: decorate with something like desiccated coconut or cacao nibs or chopped nuts.
Variations: add some green smoothie powder for added nutrient boost.
Time saver: make a batch put them in containers – you can even mix in the container or just shake to mix with the lid on, freeze and take one out before you go – it defrosts in a couple of hours or so – a great option for straight after an event like a running race. (I also like it for afternoon tea).
Written by Rebecca Speirs – find out more about Rebecca at madetomove.co
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